Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 32: My 35-Year-Old Patient Who Had A Cholecystectomy 5 Years Ago During Her Gastric Bypass Surgery Presents With Abdominal Pain And Impaired Lfts. Ct Showed A 15-Mm Cbd With A Distal Cbd Stone. Ercp Was Unsuccessful Using A Pediatric Scope. Can You Help? (continued)

Simon K. Lo, MD

On the surface, this appears to be a case of a simple bile duct stone that should be easily treated with a sphincterotomy and stone extraction during an endoscopic retrograde cholangiopancreatography (ERCP). However, this patient has a prior Roux-en-Y gastric bypass surgery, which presents a big problem in reaching the papilla. A standard duodenoscope may be long enough to get to the jejunojejunostomy, but negotiating into the afferent jejunal limb with the stiff bending section of the duodenoscope is difficult and the length of the scope is simply inadequate to approach the papilla. Similar…