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Gastric bypass is common in the United States and is often performed without synchronous cholecystectomy. The resultant rapid weight loss can lead to gallstones in up to 40% of patients, some of whom will develop choledocholithiasis. Treatment of choledocholithiasis after gastric bypass is problematic because the long Roux limb is impossible to navigate with a standard side-viewing endoscope passed through the mouth.

We demonstrate a simple technique to perform ERCP after gastric bypass by laparoscopically providing access to the gastric remnant. The purpose is to familiarize surgeons and endoscopists with the technique, as many will encounter patients such as this in everyday practice.