Special considerations: Management of common bile duct stones in the bariatric patient

After bariatric surgery, patients are at increased risk for gallstone formation and subsequent common bile duct stones. Patients who have undergone sleeve gastrectomy or placement of a restrictive gastric band may be managed in the standard fashion with endoscopic retrograde cholangiopancreatography. Those who have undergone a Roux-en-Y gastric bypass or a duodenal switch require specialized techniques to treat their common bile duct stones. These complex techniques require specialized equipment and training and typically are performed at large referral centers. The choice of technique depends on the available expertise and urgency of biliary intervention.