Laparoscopic-Assisted Percutaneous Transgastric ERCP After Gastric Bypass

Catherine L McKnight, MD, Navid Madani, MD, William S Cobb, MD, Alfredo M Carbonell, DO. Greenville Hospital System University Medical Center

Our patient is a 61 year old gentleman with a history of roux-en-Y gastric bypass four years prior to presentation. One year after his bypass, he underwent an emergent laparoscopic converted to open subtotal cholecystecomy for acute cholecystitis. Three years after his subtotal cholecystectomy he presented with abdominal pain, pruritus, jaundice, hyperbilirubinemia and elevated transaminases. Magnetic resonance cholangiopancreatography demonstrated multiple filling defects within the common bile duct.

This video will demonstrate our laparoscopic-assisted, percutaneous, transgastric approach to the excluded gastric remnant for ERCP.

Trocars were placed into the upper abdomen and the excluded gastric remnant was identified and dissected out. A 15 mm dilating tip trocar was placed through the body of the stomach and angled towards the pylorus. The transgastric trocar was accessed with a flexible endoscope for the ERCP procedure, where sphincterotomy and stone extraction were performed. The gastrotomy was sutured after removal of the transgastric trocar. Follow up at nine months demonstrates the patient has done well with no sequelae post-ERCP.

Session: VidTV1
Program Number: V056

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