Common Bile Duct Access After Bariatric Surgery: A Narrative Review of Endoscopic Considerations for Treatment of Choledocholithiasis

Choledocholithiasis after bariatric surgery presents a unique set of challenges for surgeons and gastroenterologists. This narrative review discusses the most common procedural interventions for choledocholithiasis in patients after commonly performed bariatric procedures, including laparoscopic transgastric ERCP, rendezvous ERCP, laparoscopic common bile duct exploration, cholangioscopy, and the EDGE procedure. All interventions maintain a technical and clinical success rate greater than 80%, but adverse outcome rates can vary from 8 to 22% and length of stay ranges from 1 to 17 days post procedure. Operative times range from 100 to 350 min. There are additional considerations, including procedure complexity, resource utilization, and limited availability depending on hospital system. Given the limited published literature available, there remains no commonly accepted algorithm for guiding which procedure to pursue. This review discusses considerations and reviews the current literature to offer suggestions for guidance for procedure choice in treating post-bariatric surgery patients with choledocholithiasis.