Pancreatobiliary access following Roux-en-Y gastric bypass (RYGBP) is challenging. We reviewed 32 cases of surgical gastrostomy for complex transgastric upper gastrointestinal endoscopy.
MethodsRetrospective review of prospectively collected database of patients with history of RYGBP that had surgical gastrostomy for pancreatobiliary and duodenal access at a single institution from 2004–2008. Indication for procedure, surgical findings, successful cannulation, and complications are reported.
ResultsThirty patients (25 female), with age ranging from 27 to 72, underwent 32 procedures. The indications to access the gastric remnant were sphincter of Oddi dysfunction (13), pancreatitis (six), common bile duct stone/obstruction (five), cholangitis (three), pancreatic mass evaluation (two), gastrointestinal bleed (two), and cystic duct leak after cholecystectomy (one). Mean operative time was 200 min (98–338) and estimated blood loss (mean) 85 cc (10–500). Laparoscopic gastrostomy was attempted in 28 cases with one conversion to open (3.6%). Four planned open procedures were also performed. All 30 patients underwent successful endoscopy and 28 had an endoscopic retrograde cholangiopancreatography, all with successful cannulation of the pancreatobiliary tree (100%).
ConclusionsSurgical gastrostomy is an effective means to gain access to the upper GI tract and pancreatobiliary tree following RYGBP. This technique should be considered when traditional endoscopic approaches are impossible.
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Figure 1 Similar content being viewed by others Explore related subjectsDiscover the latest articles and news from researchers in related subjects, suggested using machine learning. ReferencesPories WJ. Bariatric surgery: risks and rewards. J Clin Endocrinol Metab 2008;93(11 Suppl 1):S89–S96.
Byrne TK. Complications of surgery for obesity. Surg Clin North Am 2001;81(5):1181–1193. vii-viii.
Lord RV, Edwards PD, Coleman MJ. Gastric cancer in the bypassed segment after operation for morbid obesity. Aust N Z J Surg 1997;67(8):580–582.
Macgregor AM, Pickens NE, Thoburn EK. Perforated peptic ulcer following gastric bypass for obesity. Am Surg 1999;65(3):222–225.
Printen KJ, LeFavre J, Alden J. Bleeding from the bypassed stomach following gastric bypass. Surg Gynecol Obstet 1983;156(1):65–66.
Shiffman ML, Sugerman HJ, Kellum JH, Brewer WH, Moore EW. Gallstones in patients with morbid obesity. Relationship to body weight, weight loss and gallbladder bile cholesterol solubility. Int J Obes Relat Metab Disord 1993;17(3):153–158.
Koornstra JJ. Double balloon enteroscopy for endoscopic retrograde cholangiopancreaticography after Roux-en-Y reconstruction: case series and review of the literature. Neth J Med 2008;66(7):275–279.
Cicek B, Parlak E, Disibeyaz S, Koksal AS, Sahin B. Endoscopic retrograde cholangiopancreatography in patients with Billroth II gastroenterostomy. J Gastroenterol Hepatol 2007;22(8):1210–1213.
Faylona JM, Qadir A, Chan AC, Lau JY, Chung SC. Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy. Endoscopy 1999;31(7):546–549.
Baron TH, Vickers SM. Surgical gastrostomy placement as access for diagnostic and therapeutic ERCP. Gastrointest Endosc 1998;48(6):640–641.
Stein EG, Cynamon J, Katzman MJ, Goodman E, Rozenblit A, Wolf EL, Jagust MB. Percutaneous gastrostomy of the excluded gastric segment after Roux-en-Y gastric bypass surgery. J Vasc Interv Radiol 2007;18(7):914–919.
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):325–328.
Goitein D, Gagne DJ, Papasavas PK, McLean G, Foster RG, Beasley HS, Caushaj PF. Percutaneous computed tomography-guided gastric remnant access after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2(6):651–655.
Mori A, Ohashi N, Maruyama T, Tatebe H, Sakai K, Inoue H, Takegoshi S, Okuno M. Endoscopic retrograde cholangiopancreatography through a gastric stoma using an ultrathin endoscope: a novel approach. Endoscopy 2007;39(Suppl 1):E323.
Ceppa FA, Gagne DJ, Papasavas PK, Caushaj PF. Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2007;3(1):21–24.
Martinez J, Guerrero L, Byers P, Lopez P, Scagnelli T, Azuaje R, Dunkin B. Endoscopic retrograde cholangiopancreatography and gastroduodenoscopy after Roux-en-Y gastric bypass. Surg Endosc 2006;20(10):1548–1550.
Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 2002;56(2):225–232.
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):640–643.
Mergener K, Kozarek RA, Traverso LW. Intraoperative transjejunal ERCP: case reports. Gastrointest Endosc 2003;58(3):461–463.
Freeman ML, Gill M, Overby C, Cen YY. Predictors of outcomes after biliary and pancreatic sphincterotomy for sphincter of Oddi dysfunction. J Clin Gastroenterol 2007;41(1):94–102.
Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 2003;13(3):350–354.
Wang P, Li ZS, Liu F, Ren X, Lu NH, Fan ZN, Huang Q, Zhang X, He LP, Sun WS, Zhao Q, Shi RH, Tian ZB, Li YQ, Li W, Zhi FC. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol 2009;104(1):31–40.
Calmes JM, Giusti V, Suter M. Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg 2005;15(3):316–322.
Department of Surgery, Hennepin County Medical Center and University of Minnesota Medical Center, Minneapolis, MN, USA
Jessica M. Gutierrez, Howard Lederer, Jon C. Krook & Eric H. Jensen
Department of Gastroenterology, Hennepin County Medical Center and University of Minnesota Medical Center, Minneapolis, MN, USA
Timothy P. Kinney & Martin L. Freeman
Department of Surgery, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA
Eric H. Jensen
Correspondence to Eric H. Jensen.
About this article Cite this articleGutierrez, J.M., Lederer, H., Krook, J.C. et al. Surgical Gastrostomy for Pancreatobiliary and Duodenal Access Following Roux en Y Gastric Bypass. J Gastrointest Surg 13, 2170–2175 (2009). https://doi.org/10.1007/s11605-009-0991-7
Received: 15 June 2009
Accepted: 10 August 2009
Published: 24 September 2009
Issue Date: December 2009
DOI: https://doi.org/10.1007/s11605-009-0991-7
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