Choledocholithiasis after Bariatric Surgery-More than a Stone's Throw to Reach?

Gallstone disease is common after bariatric surgery, and patients with bile duct stones in this cohort can be difficult to treat, due to the altered anatomy. This review aims to analyse the various management options available for choledocholithiasis in post-bariatric surgery patients.

A literature search of PubMed, Medline and Cochrane library databases was carried out for studies on this subject, between January 1970 and March 2017. After initial screening and further full text review, suitable studies were identified after applying the inclusion criteria.

Twenty-nine studies were identified and analysed. Overtube-assisted endoscopy appears to be a popular technique, and 10 studies employing this technique were identified. Though there are minor variations between the three different types of overtube endoscopy, the success rate for ERCP with this approach is between 60 and 70%. Studies using a combination of radiological and endoscopic techniques report a success rate of 60-70%, though the endoscopic ultrasound-guided technique has been reported to have higher success rates (90-100%). Surgery-assisted ERCP also appears to be widely reported and has a consistently high ERCP success rate (80-100%), with an added advantage of the option to perform a concomitant cholecystectomy. There are very few reports on using surgery as the sole option in this scenario.

Both overtube-assisted endoscopy and laparoscopy-assisted ERCP appear to be safe, with good success rates. The other methods may be suitable for selected patients and centres with specific interest in such techniques.