Muhammad Aadil Hakim is pursuing medical degree at the University of Bristol, UK and very keen to pursue a career in academia and surgery. He has special interest in neurosurgery and ENT surgery. He has accomplished BSc degree in physics from King’s College London University. He held positions as president of the University of Bristol Surgery Society, the Bristol representative for NANSIG (Neurology and Neurosurgery Interest Group) and currently the vice president for NNS (the Neurosurgical and Neurological Society).

Oesophagogastroduodenoscopy (OGD) for visualization and treatment of the duodenum is technically challenging due to the mobile nature and complex foldings of the anatomy. D3 and D4 of the duodenum and the duodenal flexure are especially difficult to access with an OGD due to their distal locations. Duodenal anatomy proximal to D3 can even be difficult to access when there have been alterations to the normal gastrointestinal (GI) anatomy. Such cases include those having undergone Roux-en-Y gastric bypass surgery, who later develop biliary disease requiring endoscopic access to the biliary tree. Traditional transoral routed endoscopic retrograde cholangio-pancreatography (ERCP) is difficult in these patients due to the anatomical rearrangements. In the past these patients underwent open surgery for biliary tree access, but the associated morbidity, cost and length of post-operative recovery made this a suboptimal treatmentv. A possible solution for endoscopic distal duodenum access and biliary tree access in Rouxen- Y patients is laparoscopic transgastric endoscopy (LTGE). In this paper we report a series of patients admitted to the Bristol Royal Infirmary hospital (BRI) who were diagnosed and treated with LTGE. This case series identified LTGE as advantageous in terms of providing a shorter access route to duodeno-jejunal anatomy, which is otherwise difficult to access via traditional OGD.