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Transgastric Endoscopic Retrograde Cholangiopancreatography for the Management of Biliary Tract Disease after Roux-en-Y Gastric Bypass Treatment for Obesity

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Abstract

Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity. However, it may lead to diseases of the bilio-pancreatic tract. We evaluated transgastric endoscopic retrograde cholangiopancreatography (ERCP) for managing common biliary tract diseases in patients that underwent RYGB treatment for obesity. This prospective study was conducted between 2003 and 2010 at three medical institutions. We included 23 patients with a mean body mass index of 28.2 kg/m2 after RYGB treatment. ERCP was performed in all patients to manage biliary tract diseases within 9 to 27 months (mean 16.3 months) of RYGB surgery. The gastrotomy was conducted through the anterior wall of the greater curve of the excluded stomach. A duodenoscope was introduced in the direction of the ostomy to perform the ERCP with sphincterotomy. All patients underwent an ERCP and papillotomy without incident. Ten patients underwent simultaneous cholecystectomy. A total of 17 gallstones were removed. The average gastrotomy duration was 92.69 min; the average hospital stay was 2 days. One patient had mild acute pancreatitis that resolved clinically. There was no mortality. Laparoscopy-assisted transgastric ERCP was feasible and safe for patients after RYGB. The necessary equipment is available in most bariatric surgery centers.

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Conflict of Interest

All contributing authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Federal University of Pernambuco, Recife, Brazil

    Marcelo Falcão, Josemberg Marins Campos, Eduardo Franca & Álvaro Ferraz

  2. Gastro Obeso Center, São Paulo, Brazil

    Manoel Galvão Neto, Almino Ramos & Thiago Secchi

  3. Nucleus of Treatment of Obesity Surgery, Salvador, Brazil

    Erivaldo Alves

  4. Real e Benemérita Sociedade Portuguesa de Beneficência - Hospital São Joaquim, São Paulo, Brazil

    Fauze Maluf-Filho

  5. Rua Dr. Augusto Lopes Pontes, 895/601—Costa Azul, 41760-035, Salvador, Bahia, Brazil

    Marcelo Falcão

Authors
  1. Marcelo Falcão
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  2. Josemberg Marins Campos
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  3. Manoel Galvão Neto
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  4. Almino Ramos
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  5. Thiago Secchi
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  6. Erivaldo Alves
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  7. Eduardo Franca
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  8. Fauze Maluf-Filho
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  9. Álvaro Ferraz
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Correspondence to Marcelo Falcão.

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Falcão, M., Campos, J.M., Neto, M.G. et al. Transgastric Endoscopic Retrograde Cholangiopancreatography for the Management of Biliary Tract Disease after Roux-en-Y Gastric Bypass Treatment for Obesity. OBES SURG 22, 872–876 (2012). https://doi.org/10.1007/s11695-012-0635-y

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  • DOI: https://doi.org/10.1007/s11695-012-0635-y

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