Special Considerations: Management of Common Bile Duct Stones in the Bariatric Patient

  • Teresa S. Jones
  • Vimal K. Narula


After bariatric surgery, patients are at increased risk for gallstone formation and subsequent common bile duct stones. Patients who have undergone sleeve gastrectomy or placement of a restrictive gastric band may be managed in the standard fashion with endoscopic retrograde cholangiopancreatography. Those who have undergone a Roux-en-Y gastric bypass or a duodenal switch require specialized techniques to treat their common bile duct stones. These complex techniques require specialized equipment and training and typically are performed at large referral centers. The choice of technique depends on the available expertise and urgency of biliary intervention.


Choledocholithiasis Bariatric surgery Endoscopic retrograde cholangiopancreatography (ERCP) Balloon enteroscopy Transgastric ERCP Biliary access 


  1. 1.
    Tsirline VB, Keilani ZM, El Djouzi S, Phillips RC, Kuwada TS, Gersin K, Simms C, Stefanidis D. How frequently and when do patients undergo cholecystectomy after bariatric surgery? Surg Obes Relat Dis. 2014;10(2):313–21. doi: 10.1016/j.soard.2013.10.011.PubMedCrossRefGoogle Scholar
  2. 2.
    Li VK, Pulido N, Fajnwaks P, Szomstein S, Rosenthal R, Martinez-Duartez P. Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy. Surg Endosc. 2009;23(7):1640–4. doi: 10.1007/s00464-008-0204-6.PubMedCrossRefGoogle Scholar
  3. 3.
    Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology. 1999;117(3):632–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Hutson DG, Russell E, Schiff E, Levi JJ, Jeffers L, Zeppa R. Balloon dilatation of biliary strictures through a choledochojejuno-cutaneous fistula. Ann Surg. 1984;199(6):637–47.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Amitha Vikrama KS, Keshava SN, Surendrababu NR, Moses V, Joseph P, Vyas F, Sitaram VJ. Jejunal access loop cholangiogram and intervention using image guided access. Med Imaging Radiat Oncol. 2010;54(1):5–8. doi: 10.1111/j.1754-9485.2010.02130.x.CrossRefGoogle Scholar
  6. 6.
    Kim J, Schirmer B. Safety and efficacy of simultaneous cholecystectomy at Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5:48–53.PubMedCrossRefGoogle Scholar
  7. 7.
    Mason EE, Renquist KE. Gallbladder management in obesity surgery. Obes Surg. 2002;12(2):222–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Swartz DE, Feliz EK. Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbidly obese patients? Surg Obes Relat Dis. 2005;1:555–60.PubMedCrossRefGoogle Scholar
  9. 9.
    Patel KR, White SC, Tejirian T, et al. Gallbladder management during laparoscopic Roux-en-Y gastric bypass surgery: routine preoperative screening for gallstones and postoperative prophylactic medical treatment are not necessary. Am Surg. 2006;72:857–61.PubMedGoogle Scholar
  10. 10.
    Sugarman HJ, Brewer WH, Shiffman ML, et al. A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric bypass induced rapid weight loss. Am J Surg. 1995;169:91–6.CrossRefGoogle Scholar
  11. 11.
    Miller K, Hell E, Lang B, et al. Gallstone formation prophylaxis after gastric restrictive procedures for weight loss. Ann Surg. 2003;238:697–702.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Grover BT, Kothari SN. Biliary issues in the bariatric population. Surg Clin North Am. 2014;94(2):413–25. doi: 10.1016/j.suc.2014.01.003.PubMedCrossRefGoogle Scholar
  13. 13.
    Baron TH, Vickers SM. Surgical gastrostomy placement as access for diagnostic and therapeutic ERCP. Gastrointest Endosc. 1998;22:640–1.CrossRefGoogle Scholar
  14. 14.
    Peters M, Papsavas PK, Caushak PF, et al. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for benign common bile duct stricture after Roux-en-Y gastric bypass. Surg Endosc. 2002;16:1106.PubMedCrossRefGoogle Scholar
  15. 15.
    Facchiano E, Quartararo G, Pavoni V, et al. Laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y gastric bypass: technical features. Obes Surg. 2014;25:373.CrossRefGoogle Scholar
  16. 16.
    Richardson JF, Lee JG, Smith BR, Nguyen B, Pham KP, Nguyen NT. Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass: case series and review of the literature. Am Surg. 2012;78(10):1182–6.PubMedGoogle Scholar
  17. 17.
    Grimes KL, Maciel VH, Mata W, et al. Complications of laparoscopic transgastric ERCP in patients with Roux-en-Y gastric bypass. Surg Endosc. 2015;29:1753.PubMedCrossRefGoogle Scholar
  18. 18.
    Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg. 2013;206:457–63.PubMedCrossRefGoogle Scholar
  19. 19.
    Buxbaum J. Modern management of common bile duct stones. Gastrointest Endosc Clin N Am. 2013;23(2):251–75. doi: 10.1016/j.giec.2012.12.003.PubMedCrossRefGoogle Scholar
  20. 20.
    Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, Diamond T, Taylor MA. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2013; 9: CD003327. doi:  10.1002/14651858.CD003327.pub3
  21. 21.
    Ducoin C, Moon RC, Teixeira AF, et al. Laparoscopic choledochoduodenostomy as an alternate treatment for common bile duct stones after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2014;10:647–53.PubMedCrossRefGoogle Scholar
  22. 22.
    Ozcan N, Kahriman G, Mavili E. Percutaneous transhepatic removal of bile duct stones: results in 261 patients. Cardiovasc Intervent Radiol. 2012;35:621–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Hazey JW, McCreary M, Guy G, Melvin WS. Efficacy of percutaneous treatment of biliary tract calculi using the holmium: YAG laser. Surg Endosc. 2007;21(7):1180–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Fonetin DB, Gibson RN, Collier NA. Two decades of percutaneous transjejunal biliary intervention for benign biliary disease: a review of the intervention nature and complication. Insights Imaging. 2011;5:557–65.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA

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