title: Technique for salvage ERCP with gastric bypass anatomy and severe intra-abdominal adhesions.
abstract: BACKGROUND
  Choledocholithiasis is a complex problem in patients with Roux-en-Y gastric bypass anatomy. Several techniques of biliary clearance have been described, but these can be limited by intra-abdominal adhesions.
  
  
  METHODS
  A 36-French surgical gastrostomy was created and was allowed to mature for 10 weeks. It was exchanged for a 15-mm laparoscopic surgery trocar under fluoroscopic guidance. Endoscopic retrograde cholangiopancreatography (ERCP) was carried out using the trocar as a stable access point. Complete biliary clearance was achieved in one sitting using sphincterotomy, large-diameter biliary orifice balloon dilation, and balloon/basket sweeps.
  
  
  RESULTS
  Total endoscopy time was 120 minutes. There were no complications associated with the procedure. The postprocedure length of stay was 2 days. The total bilirubin level at discharge was 1.2 mg/dL (20 μmol/L).
  
  
  CONCLUSIONS
  In patients with gastric bypass anatomy and severe adhesions, successful salvage therapeutic ERCP can be achieved using a gastrostomy tract and a large-bore laparoscopy trocar for access to the defunctioned stomach.
authors: Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. guill_martel@hotmail.com
authors: Guillaume
authors: G
authors: Martel
authors: Ramy
authors: R
authors: Abaskharoun
authors: Stephen E
authors: SE
authors: Ryan
authors: Joseph
authors: J
authors: Mamazza
authors: Robert J
authors: RJ
authors: Fairfull-Smith
authors: Fady K
authors: FK
authors: Balaa
authors: Richard
authors: R
authors: Mimeault
mesh_terms: D000005:Abdomen; D000713:Anastomosis, Roux-en-Y; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D000267:Tissue Adhesions