Department of General Surgery, Nevill Hall Hospital, Brecon Road, Abergavenny, Wales, NP7 7EG, UK.
J Gastrointest Surg. 2018 Mar;22(3):529-537. doi: 10.1007/s11605-017-3634-4. Epub 2017 Nov 30.
Gallstone disease is common after bariatric surgery, and patients with bile duct stones in this cohort can be difficult to treat, due to the altered anatomy. This review aims to analyse the various management options available for choledocholithiasis in post-bariatric surgery patients.
A literature search of PubMed, Medline and Cochrane library databases was carried out for studies on this subject, between January 1970 and March 2017. After initial screening and further full text review, suitable studies were identified after applying the inclusion criteria.
Twenty-nine studies were identified and analysed. Overtube-assisted endoscopy appears to be a popular technique, and 10 studies employing this technique were identified. Though there are minor variations between the three different types of overtube endoscopy, the success rate for ERCP with this approach is between 60 and 70%. Studies using a combination of radiological and endoscopic techniques report a success rate of 60-70%, though the endoscopic ultrasound-guided technique has been reported to have higher success rates (90-100%). Surgery-assisted ERCP also appears to be widely reported and has a consistently high ERCP success rate (80-100%), with an added advantage of the option to perform a concomitant cholecystectomy. There are very few reports on using surgery as the sole option in this scenario.
Both overtube-assisted endoscopy and laparoscopy-assisted ERCP appear to be safe, with good success rates. The other methods may be suitable for selected patients and centres with specific interest in such techniques.
减重手术后常见胆石病，由于解剖结构改变，此类患者的胆管结石较难治疗。本综述旨在分析减重手术后患者治疗胆总管结石的各种可选治疗方案。
对 1970 年 1 月至 2017 年 3 月间发表的关于该主题的文献进行了 PubMed、Medline 和 Cochrane 图书馆数据库的检索。经过初步筛选和进一步的全文审查，应用纳入标准后确定了合适的研究。
确定并分析了 29 项研究。外套管辅助内镜检查似乎是一种流行的技术，共发现 10 项采用该技术的研究。虽然三种不同类型的外套管内镜检查有细微差异，但这种方法进行 ERCP 的成功率在 60%至 70%之间。结合放射学和内镜技术的研究报告成功率为 60%至 70%，但内镜超声引导技术的成功率更高（90%至 100%）。手术辅助 ERCP 的报道也很广泛，且 ERCP 成功率一直较高（80%至 100%），同时还可选择同期进行胆囊切除术。这种情况下，仅采用手术作为单一治疗方案的报道非常少。
外套管辅助内镜和腹腔镜辅助 ERCP 似乎都安全且成功率高。其他方法可能适合有特定兴趣的特定患者和中心。
