Abstract
Introduction: Choledocolithiasis can occur after gastric bypass. Access to the biliary is endoscopically complicated given the altered anatomy. Laparoscopic access to the distal gastric remnant can be utilized for endoscopic access to the ampulla and biliary tree for endoscopic sphincterotomy and clearance of the biliary tree without disruption of the gastric bypass. Case Description/Methods: This video demonstrates the procedure of a laparoscopic assisted ERCP following gastric bypass for morbid obesity. The patient presented with increased bilirubin and a dilated biliary tree. MRCP revealed gallstones and common bile duct stones with biliary obstruction. Laparoscopic access to the distal stomach is obtained. A cholecystectomy is performed and the distal stomach is cannulated with a 15 mm. laparoscopic trochar. An ERCP endoscope is passed through the abdominal wall, through the trochar into the distal stomach. The ampulla is identified and cannulated. A sphincterotomy was performed and the biliary tree is cleared of stones. The endoscope is withdrawn and the gastric cannulation site is surgically closed. Discussion: Laparoscopic assisted ERCP following gastric bypass for morbid obesity is a safe and effective approach for choledocolithiasis. This approach does not sacrifice or disrupt the gastric bypass. This approach is needed. Watch the video at https://tinyurl.com/ACGAbstractS377
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