Re: PSC after Gastric Bypass (Roux-N-Y)

February 7, 2007

A Roux-en-Y will probably have no effect on the progress of any of the

conditions you mentioned and will make any further bile duct stenting

a percutaneous task. What the RNY will do is remove and resolve any

strictures in the extrahepatic common bile duct. If your scarring and

blockage is primarily in the common bile duct then RNY may be your

best option rather than relying on continued ballooning and/or

stenting of strictures as they develop.

I had a RNY in 1989, primarily due to 2 severe bouts of pancreatitis

that occurred when my common bile duct blocked. I never had

pancreatitis again, but when my bilirubin started to rise several

years later, due to ducts being blocked as they left the liver, it was

difficult to get access to that area to balloon the ducts open. My RNY

was " tacked " to my right abdominal wall and the spot marked externally

with a small circle of tatoo dots - supposedly allowing a radiologist

to enter the section of bowel leading to the bile ducts by going

through the skin at that point. In practice the point of entry was

about 1/2 inch outside the circle and it took a lot of trial and error

before the right spot was found.

At the time I thought " Yes, this is the thing to do. " Years later I

question the benefit. I think, but have no way of knowing, that ERCPs

may have done as good a job of keeping the bile flowing as the RNY

without exposing my liver to the gut bacteria and that I think started

the cycle of cholangitis attacks that began after the RNY.

Tim R, ltx 1998, PSC recurrence 2002

>

> I have recently (June 2006) been diagnosed with Stage I primary

> sclerosing cholangitis, Barrett's esophagus and a moderate hiatal

> hernia. Will RNY have a positive effect on any or all of these?

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