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Management of choledocholithiasis after Roux-en-Y gastric bypass: a systematic review and pooled proportion meta-analysis

  • 2021 SAGES Oral
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Abstract

Background

Several therapeutic modalities have been proposed for the management of choledocholithiasis (CDL) following Roux-en-Y gastric bypass (RYGB), yet debate exists regarding the optimal management. The purpose of our study was to review the current literature to compare the efficacy of various techniques in the management of CDL post-RYGB.

Methods

A comprehensive search of multiple databases was conducted. Studies reporting on the management of CDL in patients post-RYGB and including at least 5 patients were eligible for inclusion. The primary outcome was successful stone clearance. Secondary outcomes included procedure duration, length of hospital stay, and adverse events.

Results

Of 3259 identified studies, 53 studies involving 857 patients were included in the final analysis. The mean age was 54.4 years (SD 7.05), 78.8% were female (SD 13.6%), and the average BMI was 30.8 kg/m2 (SD 6.85). Procedures described included laparoscopy-assisted ERCP (LAERCP), balloon-assisted enteroscopy (BAE), ultrasound-directed transgastric ERCP (EDGE), laparoscopic common bile duct exploration (LCBDE), EUS-guided intra-hepatic puncture with antegrade clearance (EGHAC), percutaneous trans-hepatic biliary drainage (PTHBD), and rendezvous guidewire-associated (RGA) ERCP. High rates of successful stone clearance were observed with LAERCP (1.00; 95% CI 0.99–1.00; p = 0.47), EDGE (0.97; 95% CI 0.9–1.00; p = 0.54), IGS ERCP (1.00; 95% CI 0.87–1.00), PTHBD (1.0; 95% CI 0.96–1.00), and LCBDE (0.99; 95% CI 0.93–1.00, p < 0.001). Lower rates of stone clearance were observed with BAE (61.5%; 95%CI 44.3–76.3, p = 0.188) and EGHAC (74.0%; 95% CI 42.9–91.5, p = 0.124). Relative to EDGE, LAERCP had a longer procedure duration (133.1 vs. 67.4 min) but lower complication rates (12.8% vs. 24.3%).

Conclusion

LAERCP and EDGE had high rates of success in the management of CDL post-RYGB. LAERCP had fewer complications but was associated with longer procedure times. BAE had lower success rates than both LAERCP and EDGE.

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Authors and Affiliations

  1. Division of General Surgery, University of Alberta, Edmonton, AB, Canada

    Matthew Connell, Warren Y. L. Sun, Valentin Mocanu, Jerry T. Dang, Noah J. Switzer, Daniel W. Birch & Shahzeer Karmali

  2. John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada

    Janice Y. Kung

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  1. Matthew Connell
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Correspondence to Warren Y. L. Sun.

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Drs. Matthew Connell, Warren Y. L. Sun, Valentin Mocanu, Jerry T. Dang, Noah J. Switzer, Daniel W. Birch, and Shahzeer Karmali, and Ms. Janice Y. Kung have no conflicts of interest to declare.

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Connell, M., Sun, W.Y.L., Mocanu, V. et al. Management of choledocholithiasis after Roux-en-Y gastric bypass: a systematic review and pooled proportion meta-analysis. Surg Endosc 36, 6868–6877 (2022). https://doi.org/10.1007/s00464-022-09018-y

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