Obesity Surgery

, Volume 28, Issue 12, pp 4064–4076 | Cite as

Comparison between Enteroscopy-Based and Laparoscopy-Assisted ERCP for Accessing the Biliary Tree in Patients with Roux-en-Y Gastric Bypass: Systematic Review and Meta-analysis

  • Alberto Machado da Ponte-NetoEmail author
  • Wanderley M. Bernardo
  • Lara M. de A. Coutinho
  • Iatagan Rocha Josino
  • Vitor Ottoboni Brunaldi
  • Diogo T. H. Moura
  • Paulo Sakai
  • Rogério Kuga
  • Eduardo G. H. de Moura
Review Article


Although balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography (BAE-ERCP) is a well-described means of accessing the duodenal papilla in patients with Roux-en-Y gastric bypass (RYGB), it is associated with modest clinical success rates. Laparoscopy-assisted ERCP (LA-ERCP)—performed by advancing a standard duodenoscope through a gastrostomy into the excluded stomach and duodenum—has emerged as a viable alternative to BAE-ERCP, with apparently higher success rates. In this systematic review, we compare LA-ERCP with enteroscopy-based techniques in post-RYGB patients, including 22 case series that provided data on papilla identification, papilla cannulation, and complications. We found that LA-ERCP was superior to the enteroscopy-based techniques in its capacity to reach the duodenal papilla, although complication rates were lower for the latter. Comparative studies are needed in order to corroborate our findings.


Balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography (BAE-ERCP) Endoscopic retrograde cholangiopancreatography Roux-en-Y gastric bypass Laparoscopy-assisted ERCP (LA-ERCP) 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent Statement

Does not apply.

Ethical Approval Statement

The study was approved by the local institutional review board.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Alberto Machado da Ponte-Neto
    • 1
    • 2
    Email author
  • Wanderley M. Bernardo
    • 3
  • Lara M. de A. Coutinho
    • 1
  • Iatagan Rocha Josino
    • 1
  • Vitor Ottoboni Brunaldi
    • 1
  • Diogo T. H. Moura
    • 1
  • Paulo Sakai
    • 1
  • Rogério Kuga
    • 1
  • Eduardo G. H. de Moura
    • 1
  1. 1.Gastrointestinal Endoscopy Unit, Gastroenterology DepartmentUniversity of Sao Paulo School of MedicineSão PauloBrazil
  2. 2.São PauloBrazil
  3. 3.Thoracic Surgery Department, Instituto do Coração (InCor, Heart Institute)University of Sao Paulo School of MedicineSão PauloBrazil

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