Percutaneous Therapy of Choledocholithiasis After Roux-en-Y Gastric Bypass and Past Excision of Gastric Remnant

Background: Obese patients who undergo Roux-en-Y gastric bypass (RNYGB) have a higher incidence of gallstones. RNYGB excludes the biliary tree from traditional evaluation with endoscopic retrograde cholangiopancreatography (ERCP). Excision of the gastric remnant further restricts options including EUS-directed and laparoscopy-assisted transgastric ERCP. Double balloon enteroscope-assisted ERCP has limited success, and transenteric ERCP exposes patients to higher perioperative risks. Given the limited therapeutic options, we report the successful percutaneous transhepatic therapy of choledocholithiasis in a patient with RNYGB and remnant gastrectomy.