Therapeutic biliary endoscopy after biliopancreatic diversion (BPD) for morbid obesity is not possible through the anatomical route. In the case of a long excluded afferent limb, the possibility to reach endoscopically the papilla through a surgical gastrostomy or jejunostomy has been reported. A case of laparoscopy-assisted ERCP performed 4 years after laparoscopic BPD with distal gastrectomy, is reported. Access to the papilla was obtained laparoscopically by enterotomy, insertion of a trocar into a jejunal loop 40 cm distal to the ligament of Treitz and passage of the duodenoscope through the trocar to the papilla. A guidewire was laparoscopically advanced into the cystic duct, and bile duct cannulation was achieved using the rendez-vous technique; endoscopic sphincterotomy and extraction of stones were successful. Laparoscopic cholecystectomy was performed and the enterotomy was sutured. The clinical course was uneventful.
Similar content being viewed by others
References
Elton E, Hanson BL, Qaseem T et al. Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc 1998; 47: 62–7.
Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 2002; 56: 225–32.
Schapira L, Falkenstein DB, Zimmon DS. Endoscopy and retrograde cholangiography via gastrostomy. Gastrointest Endosc 1975; 22: 103.
Gray R, Leong S, Marcon N et al. Endoscopic retrograde cholangiography, sphincterotomy, and gallstone extraction via gastrostomy. Gastrointest Endosc 1992; 38: 731–2.
Holderman WH, Etzkorn KP, Haring JM et al. Endoscopic retrograde cholangiopancreatography and stent placement via gastrostomy: technical aspects and clinical application. Endoscopy 1995; 1: 135–7.
Baron TH, Vickers SM. Surgical gastrostomy placement as access for diagnostic and therapeutic ERCP. Gastrointest Endosc 1998; 48: 640–1.
Peters M, Papasavas PK, Caushaj 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.
Pimentel RR, Mehran A, Szomstein S et al. Laparoscopy-assisted transgastrostomy ERCP after bariatric surgery: case report of a novel approach. Gastrointest Endosc 2004; 59: 325–8.
Ashburn HJ, Vlla-Gomez G, Foianini J et al. Operative enteroscopy: a useful tool in the evaluation and intervention of bilioenteric anastomoses. Surg Endosc 1995; 9: 1093–5.
Mergener K, Kozarek RA, Traverso W. Intraoperative ERCP: case reports. Gastrointest Endosc 2003; 58: 461–3.
Costamagna G, Mutignani M, Perri V et al. Diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy. Acta Gastroenterol Belg 1994; 57: 155–62.
Amaral JF, Thompson WR. Gallbladder disease in the morbid obese. Am J Surg 1985; 149: 551–7.
Calhoun R, Willbanks O. Coexistence of gallbladder disease and morbid obesity. Am J Surg 1987; 154: 655–8.
Mason EE, Renquist KE. Gallbladder management in obesity surgery. Obes Surg 2002; 12: 222–9.
Taylor J, Leitman IM, Horowitz M. Is routine cholecystectomy necessary at the time of Roux-en-Y gastric bypass? Obes Surg 2006; 16: 759–61.
Matera D, Foco M, Greco F et al. Role of prophylactic cholecystectomy in bariatric surgery. Hepatogastroenterology 2006; 53 (Suppl 1): 124 (abst).
Sugerman HJ, Brewer WH, Shiffmann ML et al. A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypassinduced rapid weight loss. Am J Surg 1995; 169: 91–6.
Baron TH, Harewood GC. Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials. Am J Gastroenterol 2004; 99: 1455–60.
DiSario JA, Freeman ML, Bjorkman DJ et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 2004; 127: 1291–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mutignani, M., Marchese, M., Tringali, A. et al. Laparoscopy-Assisted ERCP after Biliopancreatic Diversion. OBES SURG 17, 251–254 (2007). https://doi.org/10.1007/s11695-007-9026-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-007-9026-1