Diagnostic and therapeutic ERCP in symptomatic choledocholithiasis , via laparoscopic transgastric access , after roux-eny gastric bypass

Morbid obesity is an increasingly common problem worldwide6, and therefore, there is increasing utilization of surgical procedures for the treatment of this disease5. One of the preferred techniques is the Roux-en-Y gastric bypass. This technique which generally leads to rapid weight loss is associated with the formation of biliary calculi and consequently to its complications (e.g., acute pancreatitis, cholangitis, symptomatic choledocholithiasis and colecystitis)4;5. Endoscopic retrograde cholangiopancreatography (ERCP) which has become fi rst line treatment for the resolution of calculi of the common bile duct, faces in these patients diffi culties using the conventional route, in view of the tortuosities, angulations and distances of the intestinal loops and anastomoses2;4. A more viable technique is direct transgastric access which consists of the introduction of the duodenoscope through the bypassed stomach by a gastrostomy performed by videolaparoscopic surgery 2;8, thereby greatly facilitating access to the duodenum and duodenal papilla2.