Diagnostic and therapeutic challenges with malignant biliary tract and periampullary pathology in post-bariatric...

Patients with prior bariatric surgery present unique challenges when diagnosed with malignant periampullary and biliary tract pathology. Surgically altered gastrointestinal anatomy has significant implications for both diagnostic evaluation and therapeutic intervention, precluding a universal management algorithm. Instead, these patients require an individualized approach to pre-operative assessment, operative planning, and post-operative care. Altered anatomy may influence symptom presentation, limit conventional endoscopic access to the biliary tree, and complicate surgical reconstruction. This review examines the implications of common bariatric procedures on the evaluation and management of periampullary malignancy and proposes a practical framework to guide pancreatic surgeons in the work-up and treatment of this complex patient population.