Laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography: a review of indications, technical considerations, and outcomes

Roux-en-Y gastric bypass (RYGB) is a commonly performed surgical procedure used as a surgical treatment for obesity. Performance of endoscopic retrograde cholangiopancreatography (ERCP) is complicated by this surgical alteration in foregut anatomy, in which the duodenum and major papilla are no longer accessible in standard transoral fashion. While balloon enteroscope-assisted may be feasible in some cases following gastric bypass, technical performance of ERCP may still be limited by lack of a side viewing scope and elevator mechanism. Patients who have undergone prior RYGB and who develop a biliary or pancreatic disease indication for ERCP, the most common indication being choledocholithiasis, may be eligible for alternative interventional options. One such option is laparoscopic assisted transgastric ERCP (LATE). In this technique, laparoscopic access to the gastric remnant permits percutaneous duodenoscope passage into the gastric remnant via a laparoscopically placed trocar. Once duodenoscope access to the major papilla is achieved, standard ERCP techniques can then be employed. This review focuses on the indications, technical and logistical considerations, outcomes of LATE, and potential adverse following LATE. The review also discusses alternatives to LATE, including surgical, interventional radiologic, and endoscopicultrasaound guided approaches, as well as future considerations in the performance of LATE.