BACKGROUND: Access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass for gastrostomy tube placement or therapeutic endoscopy is a technical challenge. Available techniques include interventional radiology-placed gastrostomy, deep enteroscopy, and surgical gastrostomy; however, these techniques are hampered by complications, technical complexity, or invasiveness. OBJECTIVE: To describe a novel technique that uses EUS to insufflate the excluded gastric remnant for fluoroscopically guided percutaneous gastrostomy placement. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Ten patients who required gastrostomy placement after Roux-en-Y gastric bypass. INTERVENTIONS: EUS was used to puncture the excluded stomach through the gastric pouch or jejunum. The stomach was insufflated, and a direct percutaneous gastrostomy placed under fluoroscopic guidance in the distended stomach. MAIN OUTCOME MEASUREMENTS: Feasibility, safety, and efficacy of EUS-assisted, fluoroscopically guided gastrostomy tube placement. RESULTS: Technical success of EUS-assisted gastrostomy was achieved in 9 of 10 patients(90%). There were no complications. LIMITATIONS: Single-institution study, small sample size. CONCLUSIONS: EUS-assisted, fluoroscopically guided gastrostomy tube placement may be a safe and feasible technique to obtain enteral access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass at specialized centers.
BACKGROUND: Access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass for gastrostomy tube placement or therapeutic endoscopy is a technical challenge. Available techniques include interventional radiology-placed gastrostomy, deep enteroscopy, and surgical gastrostomy; however, these techniques are hampered by complications, technical complexity, or invasiveness. OBJECTIVE: To describe a novel technique that uses EUS to insufflate the excluded gastric remnant for fluoroscopically guided percutaneous gastrostomy placement. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Ten patients who required gastrostomy placement after Roux-en-Y gastric bypass. INTERVENTIONS: EUS was used to puncture the excluded stomach through the gastric pouch or jejunum. The stomach was insufflated, and a direct percutaneous gastrostomy placed under fluoroscopic guidance in the distended stomach. MAIN OUTCOME MEASUREMENTS: Feasibility, safety, and efficacy of EUS-assisted, fluoroscopically guided gastrostomy tube placement. RESULTS: Technical success of EUS-assisted gastrostomy was achieved in 9 of 10 patients(90%). There were no complications. LIMITATIONS: Single-institution study, small sample size. CONCLUSIONS: EUS-assisted, fluoroscopically guided gastrostomy tube placement may be a safe and feasible technique to obtain enteral access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass at specialized centers.
Authors: Tarek Sawas; Andrew C Storm; Fateh Bazerbachi; Chad J Fleming; Eric J Vargas; Vinay Chandrasekhara; James C Andrews; Michael J Levy; John A Martin; Bret T Petersen; Mark D Topazian; Barham K Abu Dayyeh Journal: Surg Endosc Date: 2019-05-28 Impact factor: 4.584
Authors: Michel Kahaleh; Everson L A Artifon; Manuel Perez-Miranda; Monica Gaidhane; Carlos Rondon; Takao Itoi; Marc Giovannini Journal: World J Gastroenterol Date: 2015-01-21 Impact factor: 5.742
Authors: Aaron Martin; Charles Andrew Kistler; Piotr Wrobel; Juliana F Yang; Ali A Siddiqui Journal: Endosc Ultrasound Date: 2016 May-Jun Impact factor: 5.628
Authors: Christophe Snauwaert; Pierre Laukens; Bruno Dillemans; Jacques Himpens; Danny De Looze; Pierre Henri Deprez; Abdenor Badaoui Journal: Endosc Int Open Date: 2015-06-23