title: Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass: case series and review of the literature.
abstract: Endoscopic access to the gastric remnant and pancreatobiliary tree is technically difficult after Roux-en-Y gastric bypass even when facilitated by the use of specialized techniques such as balloon enteroscopy and the use of overtubes. Furthermore, such techniques are not universally  available at all medical centers. We describe a case series of 13 patients with a history of Roux-en-Y gastric bypass for the treatment of morbid obesity who underwent laparoscopic transgastric endoscopy through the gastric remnant to access the duodenum or biliary tree. Charts of these patients  were reviewed for demographics, indications for procedure, length of stay, morbidity, and mortality. Four of the patients had failed prior attempts to access the excluded anatomy through traditional transoral endoscopy. Two patients underwent transgastric endoscopy for evaluation of gastrointestinal  bleeding. Of the 11 patients for whom endoscopic retrograde cholangiopancreatography was planned, all underwent successful biliary cannulation and sphincterotomy. There were no conversions to an open procedure or complications during the follow-up period. Laparoscopic transgastric endoscopy  is a safe and reliable method to access the excluded stomach and biliary tree in patients with a history of Roux-en-Y gastric bypass.
authors.affiliation: Department of Surgery, University of California, Irvine, Medical Center, Orange, California 92868, USA.
authors.forename: Jason F
authors.initials: JF
authors.lastname: Richardson
authors.forename: John G
authors.initials: JG
authors.lastname: Lee
authors.forename: Brian R
authors.initials: BR
authors.lastname: Smith
authors.forename: Brian
authors.initials: B
authors.lastname: Nguyen
authors.forename: Kathleen P
authors.initials: KP
authors.lastname: Pham
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass; D018530:Gastric Stump; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies