Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

Abstract

Background: The prevalence and increase of obesity in the world are that 2.3 billion adults were overweight and 700 million adults were obese in 2015. In the context of the morbid obesity pandemic, bariatric surgery was presented as a gold standard treatment. It is known that the prevalence of cholelithiasis is 3 to 4 times higher in morbidly obese patients when compared to the general population. Literature reports that the first attempts to approach the biliary tract in patients with gastric bypass in Roux-en-Y, were performed transorally and had resulted in low success rates. The aim of this study was to analyze the results of the use of the endoscopic transgastrostomy technique for the treatment of biliary tract diseases in patients submitted to Y-de-Roux bypass. Methods: Between August 2010 and December 2014, procedures of transgastrostomy endoscopic retrograde cholangiopancreatography (TG-ERCP) were performed in six patients, previously submitted to Roux-en-Y gastric bypass for treatment of morbid obesity. Results: All patients were successfully submitted to procedures for duodenal papilla catheterization, cholangiography, and endoscopic papillotomy. No complications related to the surgical or endoscopic procedure were observed in the cases described, despite the small sample studied and also the variation of age and body mass index (BMI). Conclusions: The technique described in the current study has been shown to be safe and effective. The possibility of performing it in single surgical time, as well as the use of conventional duodenoscopes and their accessories, make it a choice in patients undergoing Roux-en-Y gastric bypass. J Curr Surg. 2017;7(4):58-63 doi: https://doi.org/10.14740/jcs336e