[Laparoscopy-assisted ERCP after gastric bypass surgery]

Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with Roux-en‑Y gastric bypass or omega loop reconstruction due to altered gastrointestinal anatomy. At the same time, this patient population has an increased risk for the development of cholelithiasis and choledocholithiasis after bariatric surgery, frequently requiring interventional biliary treatment.

This retrospective single-center study analyzed patients who underwent laparoscopy-assisted transgastric ERCP (LA-ERCP) after bariatric surgery between October 2018 and April 2025. In this study six patients with prior Roux-en‑Y gastric bypass or omega loop reconstruction underwent a total of seven LA-ERCP procedures for choledocholithiasis. Clinical characteristics, procedural success, operation time and postoperative complications were evaluated.

Successful papillotomy and complete bile duct stone clearance were achieved in all cases. Simultaneous laparoscopic cholecystectomy was performed in three procedures. No conversion to open surgery was required. The mean duration of surgery was 156 ± 29.6 min. Postoperative complications occurred in two cases and were managed conservatively or endoscopically. The median hospital stay was 5 days.

The LA-ERCP procedure is a safe and effective treatment option for choledocholithiasis in patients after bariatric surgery. Although the procedure is more invasive than purely endoscopic alternatives, it offers high technical success rates and enables the use of standard ERCP equipment. The LA-ECRP procedure provides a decisive advantage, particularly when simultaneous cholecystectomy is indicated.