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Paired editorial: Systematic review of transgastric ERCP in Roux-en-Y gastric bypass patients

      As more individuals undergo Roux-en-Y gastric bypass (RYGB), more medical providers encounter the positive and negative consequences of surgically altered intestinal anatomy. The configuration of a RYGB impairs transoral endoscopic access to the remnant stomach, duodenum, and biliary tree. This complicates the diagnosis and treatment of pathology localized to these excluded anatomic regions, such as ulcers, sources of bleeding, malignancies, and biliary obstructions [
      • Hintze R.E.
      • Adler A.
      • Veltzke W.
      • Abou-Rebyeh H.
      Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with Billroth II or Roux-en-Y gastrojejunostomy.
      ,
      • Wright B.E.
      • Cass O.W.
      • Freeman M.L.
      ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla.
      ]. Furthermore, RYGB often results in rapid weight reduction, which is associated with the development of cholelithiasis that may progress to choledocholithiasis, a condition conventionally treated with transoral endoscopic retrograde cholangiopancreatography (ERCP) [
      • Iglézias Brandão de Oliveira C.
      • Adami Chaim E.
      • da Silva B.B.
      Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery.
      ]. Thus, RYGB concurrently increases the probability of developing choledocholithiasis and decreases the probability that minimally invasive treatments of this condition will be successful.
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      Linked Article

      • Systematic review of transgastric ERCP in Roux-en-Y gastric bypass patients
        Surgery for Obesity and Related DiseasesVol. 13Issue 7
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          Balloon-assisted endoscopic retrograde cholangiopancreatoscopy (ERCP) in Roux-en-Y gastric bypass (RYGB) patients is technically challenging due to anatomic and accessory constraints, thus success rates are modest. Transgastric ERCP (TG-ERCP) offers a viable alternative. We aimed to systematically review the literature on TG-ERCP in RYGB patients to better define the technical approaches, success rates, and adverse events of this procedure. A computer-assisted search of the Embase and PubMed databases was performed to identify studies that focused on the techniques and clinical outcomes of TG-ERCP.
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