Advertisement

Management of Common Bile Duct Stones in the Presence of Prior Roux-en-Y

  • Andrew T. Strong
  • Matthew KrohEmail author
Chapter

Abstract

Roux-en-Y (RNY) intestinal anatomy is increasingly common among several unique patient populations. RNY gastric bypass for weight loss is the prototypical example. RNY foregut anatomy precludes facile transoral access to the papilla by endoscopic retrograde cholangiopancreatography (ERCP), and alternative techniques to access must be established for biliary access to treat stones and other disease processes. The technique used for management of choledocholithiasis in the presence of RNY depends on several factors, including the clinical stability of the patient, stone size, local equipment availability, and technical expertise of proceduralists. This chapter reviews the current endoscopic, percutaneous, surgical, and various hybrid techniques which are available to treat stones and biliary diseases after prior RNY.

Keywords

Choledocholithiasis Roux-en-y Endoscopic retrograde cholangiopancreatography Percutaneous biliary drainage Endoscopy 

References

  1. 1.
    English WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2018;14(3):259–63.CrossRefGoogle Scholar
  2. 2.
    Brethauer SA, Kothari S, Sudan R, Williams B, English WJ, Brengman M, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis. 2014;10(5):952–72.PubMedCrossRefGoogle Scholar
  3. 3.
    Wattchow DA, Hall JC, Whiting MJ, Bradley B, Iannos J, Watts JM. Prevalence and treatment of gall stones after gastric bypass surgery for morbid obesity. Br Med J Clin Res Ed. 1983;286(6367):763.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000;12(12):1347–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin N Am. 2010;39(2):157–69.. viiCrossRefGoogle Scholar
  6. 6.
    Scott DJ, Villegas L, Sims TL, Hamilton EC, Provost DA, Jones DB. Intraoperative ultrasound and prophylactic ursodiol for gallstone prevention following laparoscopic gastric bypass. Surg Endosc. 2003;17(11):1796–802.PubMedCrossRefGoogle Scholar
  7. 7.
    De Koning M, Moreels TG. Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery. BMC Gastroenterol. 2016;16(1):98.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Lopes TL, Clements RH, Wilcox CM. Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video). Gastrointest Endosc. 2009;70(6):1254–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Saleem A, Levy MJ, Petersen BT, Que FG, Baron TH. Laparoscopic assisted ERCP in Roux-en-Y gastric bypass (RYGB) surgery patients. J Gastrointest Surg. 2012;16(1):203–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Madhusudhan KS, Gamanagatti S, Srivastava DN, Gupta AK. Radiological interventions in malignant biliary obstruction. World J Radiol. 2016;8(5):518.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Kühn JP, Busemann A, Lerch MM, Heidecke CD, Hosten N, Puls R. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts. Am J Roentgenol. 2010;195(4):851–7.CrossRefGoogle Scholar
  12. 12.
    Cannavale A, Bezzi M, Cereatti F, Lucatelli P, Fanello G, Salvatori FM, et al. Combined radiological-endoscopic management of difficult bile duct stones: 18-year single center experience. Ther Adv Gastroenterol. 2015;8(6):340–51.CrossRefGoogle Scholar
  13. 13.
    Rimon U, Kleinmann N, Bensaid P, Golan G, Garniek A, Khaitovich B, et al. Percutaneous transhepatic endoscopic holmium laser lithotripsy for intrahepatic and choledochal biliary stones. Cardiovasc Intervent Radiol. 2011;34(6):1262–6.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Ahmed AR, Husain S, Saad N, Patel NC, Waldman DL, O’Malley W. Accessing the common bile duct after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(6):640–3.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Ahmed S, Schlachter TR, Hong K. Percutaneous transhepatic cholangioscopy. Tech Vasc Interv Radiol. 2015;18(4):201–9.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Hwang MH, Tsai CC, Mo LR, Yang CT, Yeh YH, Yau MP, et al. Percutaneous choledochoscopic biliary tract stone removal: experience in 645 consecutive patients. Eur J Radiol. 1993;17(3):184–90.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Mönkemüller K, McGuire B, Wilcox CM, Ramesh J, DuBay D, Eckhoff D. Percutaneous balloon dilation and placement of endoscopic biliary stent by using the double-balloon enteroscopy ERCP rendezvous technique. Gastrointest Endosc. 2013;78(2):383–5.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Choi EK, Chiorean MV, Coté GA, El Hajj II, El Hajj I, Ballard D, et al. ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery. Surg Endosc. 2013;27(8):2894–9.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Emmett DS, Mallat DB. Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series. Gastrointest Endosc. 2007;66(5):1038–41.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Liu K, Joshi V, Saxena P, Kaffes AJ. Predictors of success for double balloon-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anastomosis. Dig Endosc. 2017;29(2):190–7.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Shah RJ, Smolkin M, Yen R, Ross A, Kozarek RA, Howell DA, et al. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc. 2013;77(4):593–600.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Shao X-D, Qi X-S, Guo X-Z. Endoscopic retrograde cholangiopancreatography with double balloon enteroscope in patients with altered gastrointestinal anatomy: a meta-analysis. Saudi J Gastroenterol Off J Saudi Gastroenterol Assoc. 2017;23(3):150–60.Google Scholar
  24. 24.
    Schapira L, Falkenstein DB, Zimmon DS. Endoscopy and retrograde cholangiography via gastrostomy. Gastrointest Endosc. 1975;22(2):103.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Baron TH, Vickers SM. Surgical gastrostomy placement as access for diagnostic and therapeutic ERCP. Gastrointest Endosc. 1998;48(6):640–1.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Pimentel RR, Mehran A, Szomstein S, Rosenthal R. Laparoscopy-assisted transgastrostomy ERCP after bariatric surgery: case report of a novel approach. Gastrointest Endosc. 2004;59(2):325–8.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Ceppa FA, Gagné DJ, Papasavas PK, Caushaj PF. Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(1):21–4.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Nguyen NT, Hinojosa MW, Slone J, Lee J, Khiatani V, Wilson SE. Laparoscopic transgastric access to the biliary tree after Roux-en-Y gastric bypass. Obes Surg. 2007;17(3):416–9.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Nakao FS, Mendes CJ, Szego T, Ferrari AP. Intraoperative transgastric ERCP after a Roux-en-Y gastric bypass. Endoscopy. 2007;39(Suppl 1):E219–20.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Patel JA, Patel NA, Shinde T, Uchal M, Dhawan MK, Kulkarni A, et al. Endoscopic retrograde cholangiopancreatography after laparoscopic Roux-en-Y gastric bypass: a case series and review of the literature. Am Surg. 2008;74(8):689–93; discussion 693–694.PubMedGoogle Scholar
  31. 31.
    Dapri G, Himpens J, Buset M, Vasilikostas G, Ntounda R, Cadière GB. Video. Laparoscopic transgastric access to the common bile duct after Roux-en-Y gastric bypass. Surg Endosc. 2009;23(7):1646–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Manassa E, Assalia A, Mahajna A. Laparoscopic intraoperative ERCP through a transgastric approach after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(4):e43–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Sur A, Sur H, Khan MA. Laparoscopic-assisted endoscopic retrograde cholangiopancreatography post bariatric surgery: how to overcome the technical challenges. J Surg Case Rep. 2015;2015(3):rjv011.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Melero Abellán A, Gumbau Puchol V, Mir Labrador J. Laparoscopy assisted transgastric endoscopic retrograde cholangiopancreatography for the management of choledocholithiasis in a patient with Roux-en-Y gastric bypass. Cir Esp. 2016;94(2):111–3.PubMedCrossRefGoogle Scholar
  35. 35.
    Roberts KE, Panait L, Duffy AJ, Jamidar PA, Bell RL. Laparoscopic-assisted transgastric endoscopy: current indications and future implications. J Soc Laparoendosc Surg. 2008;12(1):30–6.Google Scholar
  36. 36.
    Gutierrez JM, Lederer H, Krook JC, Kinney TP, Freeman ML, Jensen EH. Surgical gastrostomy for pancreatobiliary and duodenal access following Roux en Y gastric bypass. J Gastrointest Surg. 2009;13(12):2170–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Bertin PM, Singh K, Arregui ME. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: case series and a description of technique. Surg Endosc. 2011;25(8):2592–6.PubMedCrossRefGoogle Scholar
  38. 38.
    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
  39. 39.
    Falcão M, Campos JM, Galvão Neto M, Ramos A, Secchi T, Alves E, et al. Transgastric endoscopic retrograde cholangiopancreatography for the management of biliary tract disease after Roux-en-Y gastric bypass treatment for obesity. Obes Surg. 2012;22(6):872–6.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Grimes KL, Maciel VH, Mata W, Arevalo G, Singh K, Arregui ME. Complications of laparoscopic transgastric ERCP in patients with Roux-en-Y gastric bypass. Surg Endosc. 2015;29(7):1753–9.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Snauwaert C, Laukens P, Dillemans B, Himpens J, De Looze D, Deprez P, et al. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography in bariatric Roux-en-Y gastric bypass patients. Endosc Int Open. 2015;03(05):E458–63.CrossRefGoogle Scholar
  42. 42.
    Abbas AM, Strong AT, Diehl DL, Brauer BC, Lee IH, Burbridge R, et al. Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass. Gastrointest Endosc. 2018;87(4):1031–9.Google Scholar
  43. 43.
    Peters M, Papasavas PK, Caushaj PF, Kania RJ, Gagné DJ. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for benign common bile duct stricture after Roux-en-Y gastric bypass. Surg Endosc. 2002;16(7):1106.PubMedCrossRefGoogle Scholar
  44. 44.
    Martinez J, Guerrero L, Byers P, Lopez P, Scagnelli T, Azuaje R, et al. Endoscopic retrograde cholangiopancreatography and gastroduodenoscopy after Roux-en-Y gastric bypass. Surg Endosc. 2006;20(10):1548–50.PubMedCrossRefGoogle Scholar
  45. 45.
    Goitein D, Gagné DJ, Papasavas PK, McLean G, Foster RG, Beasley HS, et al. Percutaneous computed tomography-guided gastric remnant access after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2(6):651–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Shaikh SH, Stenz JJ, McVinnie DW, Morrison JJ, Getzen T, Carlin AM, et al. Percutaneous gastric remnant gastrostomy following Roux-en-Y gastric bypass surgery: a single tertiary center’s 13-year experience. Abdom Radiol N Y. 2017;43(6):1464–71.CrossRefGoogle Scholar
  47. 47.
    Stein EG, Cynamon J, Katzman MJ, Goodman E, Rozenblit A, Wolf EL, et al. Percutaneous gastrostomy of the excluded gastric segment after Roux-en-Y gastric bypass surgery. J Vasc Interv Radiol JVIR. 2007;18(7):914–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Mangram AJ, Horan TC, Pearson ML, Christine Silver L, Jarvis WR. Guideline for prevention of surgical site infection. 1999 [Internet]. Centers for Disease Control; 1999. [Cited 2016 Jul 14]. Available from: https://www.cdc.gov/hicpac/pdf/guidelines/SSI_1999.pdf.
  49. 49.
    Banerjee N, Parepally M, Byrne TK, Pullatt RC, Coté GA, Elmunzer BJ. Systematic review of transgastric ERCP in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13(7):1236–42.CrossRefGoogle Scholar
  50. 50.
    Frederiksen NA, Tveskov L, Helgstrand F, Naver L, Floyd A. Treatment of common bile duct stones in gastric bypass patients with laparoscopic transgastric endoscopic retrograde cholangiopancreatography. Obes Surg. 2017;27(6):1409–13.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Lopes TL, Clements RH, Wilcox CM. Laparoscopy-assisted transjejunal ERCP in a patient with Roux-en-Y reconstruction following partial gastrectomy. J Laparoendosc Adv Surg Tech A. 2010;20(1):55–8.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Surdeanu IR, El Moussaoui I, Dika M, Des Marez B, Closset J, Mehdi A. Laparoscopy-assisted transjejunal ERCP in a patient with roux-en-Y gastric bypass. Acta Chir Belg. 2016;1–7.Google Scholar
  53. 53.
    Baron TH, Song LMWK. Percutaneous assisted transprosthetic endoscopic therapy (PATENT): expanding gut access to infinity and beyond! (with video). Gastrointest Endosc. 2012;76(3):641–4.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Law R, Wong Kee Song LM, Petersen BT, Baron TH. Single-session ERCP in patients with previous Roux-en-Y gastric bypass using percutaneous-assisted transprosthetic endoscopic therapy: a case series. Endoscopy. 2013;45(8):671–5.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Kedia P, Tyberg A, Kumta NA, Gaidhane M, Karia K, Sharaiha RZ, et al. EUS-directed transgastric ERCP for Roux-en-Y gastric bypass anatomy: a minimally invasive approach. Gastrointest Endosc. 2015;82(3):560–5.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Kedia P, Sharaiha RZ, Kumta NA, Kahaleh M. Internal EUS-directed transgastric ERCP (EDGE): game over. Gastroenterology. 2014;147(3):566–8.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Diehl DL, Gabrielsen JD, Strodel WE. The challenges of endoscopic retrograde cholangiopancreatography in gastric bypass patients: the game is not yet over. Gastroenterology. 2015;148(4):857–8.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Abu Dayyeh BK, Thompson CC, Gostout C. Endoscopic retrograde cholangiopancreatography after Roux-en-Y gastric bypass: challenges and cautions. Gastroenterology. 2015;148(4):858–9.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  1. 1.Department of General SurgeryDigestive Disease and Surgery Institute, Cleveland ClinicClevelandUSA
  2. 2.Digestive Disease Institute, Cleveland Clinic Abu DhabiAbu DhabiUnited Arab Emirates

Personalised recommendations