Success with Modified ERCP In Patients with Gastric Bypass - Abstract
Introduction: Obesity is a complex multifactorial phenotype; inter-individual variation in such phenotypes is thought to result from the action of multiple genes and environmental factors. Bariatric surgery provides the most efficient and sustained treatment for morbid obesity. Roux en-Y-gastris bypass (RYGPB) is a lithogenic risk factor due to rapid weight loss. The lithogenic effect of rapid weight loss is seen as early as four weeks although it generally appears within 7-18 months. Other complications of cholelithiasis (i.e., acute cholecystitis, choledocholithiasis, cholestatic jaundice, acute cholangitis, acute pancreatitis) might increase as well during obesity or rapid weight loss, as gallstone prevalence also increases. The presence of gallstones in the common bile duct (CBD) although is a rare complication after RYGBP, represents an important challenge due to the anatomical modifications of the gastrointestinal tract. A solution that has been found to access the excluded stomach through laparoscopy and inserting the endoscope through a gastrotomy allowing to perform an ERCP like in a traditional way. Objective: We present two cases of patients with a history of gastric bypass who presented bile duct obstruction and we performed laparoscopic-assisted ERCP. Results: We present 2 patients with history of RYGB who underwent laparoscopic assisted transgastric ERCP. The mean body mass index after RYGB was 31 kg/m2. ERCP was performed to manage choledocholitiasis within 6-7 years (mean 78 months) of RYGB surgery. The mean duration of the procedure was 185 ± 25 min; the average hospital stay was 2.5 ± .5 days. No complications were develop after the procedure. Conclusions: transgastric endoscopic retrograde cholangiopancreatography is safe and feasible for the management of biliary tract disease in patients with history of Rouxen-Y gastric bypass.