title: Laparoscopy-assisted ERCP after biliopancreatic diversion.
abstract: Therapeutic biliary endoscopy after biliopancreatic diversion (BPD) for morbid obesity is not possible through the anatomical route. In the case of a long excluded afferent limb, the possibility to reach endoscopically the papilla through a surgical gastrostomy or jejunostomy has been reported. A case of laparoscopy-assisted ERCP performed 4 years after laparoscopic BPD with distal gastrectomy, is reported. Access to the papilla was obtained laparoscopically by enterotomy, insertion of a trocar into a jejunal loop 40 cm distal to the ligament of Treitz and passage of the duodenoscope through the trocar to the papilla. A guidewire was laparoscopically advanced into the cystic duct, and bile duct cannulation was achieved using the rendez-vous technique; endoscopic sphincterotomy and extraction of stones were successful. Laparoscopic cholecystectomy was performed and the enterotomy was sutured. The clinical course was uneventful.
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mutignani
authors.forename: Michele
authors.initials: M
authors.lastname: Marchese
authors.forename: Andrea
authors.initials: A
authors.lastname: Tringali
authors.forename: Roberto Maria
authors.initials: RM
authors.lastname: Tacchino
authors.forename: Daniele
authors.initials: D
authors.lastname: Matera
authors.forename: Maurizio
authors.initials: M
authors.lastname: Foco
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D015904:Biliopancreatic Diversion; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D016717:Sphincterotomy, Endoscopic / Q000379:methods