Temporary Biliary Stent Placement for Benign Stricture with Laparoscopic-Assisted Endoscopic Stent Retrieval in a Patient Status Post Roux-en-Y Gastric Bypass: A Multidisciplinary Approach to a Complex Condition

Biliary ductal strictures are multifactorial and categorized based on their benign or malignant etiology. Treatment strategies for benign biliary strictures are complex and frequently require multiple interventions to achieve longterm results. In patients with prior upper gastrointestinal surgery, such as Roux-en-Y gastric bypass, options are more limited due to the difficulty of an endoscope to reach the biliary ductal system for diagnostic or therapeutic intervention. Newer techniques, including balloon-assisted enteroscopy, have allowed for access to the biliary system in surgically altered anatomy but completion of the planned intervention remains difficult.1,2 In Roux-en-Y bypass patients, the technical enteroscopic success of 80% and endoscopic retrograde cholangiopancreatography (ERCP) success of 70% have been reported, but these include few cases of biliary stricture.3 In patients with an inaccessible ductal system by ERCP, permanent bile duct stent placement for benign strictures has traditionally been a last resort approach for nonsurgical candidates in which cholangioplasty has failed. Bile ducts stents will inevitably occlude, and metallic stents used to treat benign strictures have demonstrated patency rates of 25% at 36 months.4 We present a case detailing a novel approach to a patient with biliary stricture following Roux-en-Y gastric bypass with remnant gastrectomy and multiple failed attempts at serial percutaneous catheter dilatations. Following interventional