Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreaticography after Roux-en-Y Gastric Bypass

Roux-en-Y gastric bypass (RYGB) anatomy has historically been considered to be a relative contraindication to endoscopic retrograde cholangiopancreaticography (ERCP) due to the challenges associated with navigating the length of the roux limb and locating the major duodenal papilla through a standard side-viewing duodenoscope. Of these 11 patients, we succeeded in placing the 12-mm balloon trocar for facilitation of ERCP in 10 cases, after which point papillary cannulation and sphincterotomy were consistently performed with satisfactory results, i.e., resolution of choledocholithiasis or improvement in pain related to a tight sphincter of Oddi dysfunction.