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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2021; 12(02): 107-111
DOI: 10.1055/s-0041-1728221
Case Report

Laparoscopy-Assisted Transgastric ERCP: A Challenging Technique for Biliary Clearance Post Roux-en-Y Gastric Bypass

Hitendra Kumar Garg
1   Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi, India
,
Pankaj Singh
1   Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi, India
,
Atul N. C. Peters
2   Department of Bariatric, Minimal Access and General Surgery, Max Smart Super Speciality Hospital, New Delhi, India
,
Shalabh Agarwal
2   Department of Bariatric, Minimal Access and General Surgery, Max Smart Super Speciality Hospital, New Delhi, India
,
Yogesh Gautam
2   Department of Bariatric, Minimal Access and General Surgery, Max Smart Super Speciality Hospital, New Delhi, India
,
Dhruv Kant Mishra
1   Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi, India
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Abstract

Biliary complications after Roux-en-Y gastric bypass (RYGB) are not uncommon. Managing choledocholithiasis in this subset of patients is challenging as conventional endoscopic retrograde cholangiopancreatography (ERCP) is not possible due to lack of peroral access to the second part of duodenum. Enteroscopic approach, however, theoretically feasible is difficult and cumbersome, often resulting in failed procedure. Small series has reported higher success with a novel technique of laparoscopic transgastric access for ERCP. Laparoscopy-assisted ERCP (LA-ERCP) is now increasingly being recognized as a safe and reliable technique for biliary clearance with a low complication rate, making it a preferred approach for managing biliopancreatic disease in these groups of patients. Here we report a case of a young patient with gallstone disease and choledocholithiasis presenting with obstructive jaundice post RYGB who was successfully managed by LA-ERCP followed by laparoscopic cholecystectomy in the same session.

Keywords

Roux-en-Y gastric bypass - RYGB - laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography - LA-ERCP


Publication History

Article published online:
03 February 2022

© 2021. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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