Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography (ERCP) for Bile Duct Stones After Roux-en-Y-Gastric
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ORIGINAL CONTRIBUTIONS
Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography (ERCP) for Bile Duct Stones After Roux-en-Y-Gastric Bypass: Single-Centre Experience Muwaffaq Mezeil Telfah 1 Richard Welbourn 1
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& Hamish Noble & David Mahon & Matthew Mason & Marianne Hollyman & Rudi Matull &
Received: 30 April 2020 / Revised: 2 September 2020 / Accepted: 3 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Gallstones are common in bariatric patients due to obesity and rapid weight loss. Bile duct stones after Roux-en-Y gastric bypass (RYGB) pose a technical challenge. We present our experience in management of bile duct stones following RYGB using laparoscopic-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP). Materials and Methods Retrospective review of RYGB patients who had endoscopic intervention for bile duct stones between 2010 and 2019. We assessed demographic and clinical outcomes. Results There were 12 patients: 9 females, median age 64 years (range 34–73), median ASA score 3 (range 2–3), and median body mass index (BMI) 30 kg/m2 (range 24.4–46). Median time of presentation since RYGB was 5 years (range 6–96 months). Clinical presentations were biliary pain with deranged liver function tests (n = 8, 67%) and cholangitis (n = 4, 33%). Ten patients (83%) had cholecystectomy prior to presentation. LA-ERCP was performed in all 12 patients. It was successful in 10 patients (83%) of which 7 were performed as a primary intervention for bile duct stones and 3 were for residual stones following previous bile duct exploration. Two out of 12 LA-ERCPs (17%) were converted to open duct clearance. Median overall hospital stay was 2.5 days (range 1–10). One patient developed post-ERCP pancreatitis; one had chronic pain. There was no major complication or mortality. Conclusion LA-ERCP is feasible for bile duct stones after RYGB and can clear the duct primarily or following previous surgical exploration. It also provides an opportunity to perform cholecystectomy and diagnostic laparoscopy. Keywords Laparoscopic-assisted ERCP . Roux-en-Y gastric bypass . Bile duct stones . Common bile duct exploration
Introduction Gallstones are found in around 10–15% of the adult population in the UK [1]. Symptomatic gallstones result in about
66,660 hospitalisations, and cholecystectomy is one of the commonest procedures with around 61,220 performed every year in the UK, costing about £111.6 million [1]. Stones in the bile ducts complicate 10–15% of symptomatic gallstones [2].
* Muwaffaq Mezeil Telfah [email protected]
Rudi Matull [email protected] Richard Welbourn [email protected]
Hamish Noble [email protected] David Mahon [email protected]
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Department Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton TA1 5DA, UK
Matthew Mason [email protected]
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Department of Gastroenterology, Musgrove Park Hospital, Taunton TA1 5DA, UK
Marianne Hollym
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