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Papasavas P, Docimo S, Oviedo RJ, Eisenberg D. Biliopancreatic access following anatomy-altering bariatric surgery: a literature review. Surg Obes Relat Dis 2021; 18:21-34. [PMID: 34688572 DOI: 10.1016/j.soard.2021.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut.
| | - Salvatore Docimo
- Division of Bariatric, Foregut, and Advanced GI Surgery, Stony Brook Medicine, Stony Brook, New York
| | | | - Dan Eisenberg
- Department of Surgery, Stanford University and Palo Alto VA Health Care Center, Palo Alto, California
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Wisneski AD, Carter J, Nakakura EK, Posselt A, Rogers SJ, Cello JP, Arain M, Kirkwood KS, Hirose K, Stewart L, Corvera CU. Ampullary stenosis and choledocholithiasis post Roux-En-Y gastric bypass: challenges of biliary access and intervention. HPB (Oxford) 2020; 22:1496-1503. [PMID: 32340857 DOI: 10.1016/j.hpb.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/13/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ampullary stenosis following Roux-en-Y gastric bypass (RYGB) is increasingly encountered. We describe cases of biliary obstruction from ampullary stenosis and choledocholithiasis to illustrate the associated diagnostic and interventional challenges with this condition. METHODS We reviewed medical records of patients with prior RYGB who underwent a biliary access procedure or surgery for non-malignant disease from January 2012-December 2018. RESULTS We identified 15 patients (4 male, 11 female; mean age 53.7 years) who had RYGB on average 11.7 years (range 1-32) years before diagnosis of biliary obstruction. Fourteen patients reported abdominal pain, 5 had nausea/emesis, 12 had elevated liver function tests, and 6 had ascending cholangitis. Mean common bile duct (CBD) diameter at presentation was 16.9 mm (range 4.0-25.0 mm). Operations included 3 transduodenal ampullectomies (2 with biliary bypass), 2 CBD explorations with stone extraction, 1 laparoscopic cholecystectomy alone, 1 Whipple procedure, 1 balloon enteroscopy with sphincterotomy, and 7 transgastric endoscopic retrograde cholangiopancreatography. All ampulla pathology was benign in patients who underwent resection. At follow-up (mean 15.4 months; range 0.23-44.5 months), 12/15 (80%) reported symptom resolution or improvement. DISCUSSION Ampullary stenosis after RYGB presents challenges for diagnostic evaluation and intervention, often requiring multi-disciplinary expertise. The underlying pathology remains to be elucidated.
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Affiliation(s)
- Andrew D Wisneski
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Jonathan Carter
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Eric K Nakakura
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Andrew Posselt
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Stanley J Rogers
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - John P Cello
- University of California San Francisco, Department of Medicine, Division of Gastroenterology, 513 Parnassus Avenue, S-357, San Francisco, CA, 94143-0538, United States
| | - Mustafa Arain
- University of California San Francisco, Department of Medicine, Division of Gastroenterology, 513 Parnassus Avenue, S-357, San Francisco, CA, 94143-0538, United States
| | - Kimberly S Kirkwood
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Kenzo Hirose
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Lygia Stewart
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States; San Francisco Veterans Affairs Medical Center, Department of Surgery, 4150 Clement Street, Box 112, San Francisco, CA, 94121, United States
| | - Carlos U Corvera
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States; San Francisco Veterans Affairs Medical Center, Department of Surgery, 4150 Clement Street, Box 112, San Francisco, CA, 94121, United States.
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