Endoscopic Gastrostomy After Bariatric Surgery: A Unique Approach

Abstract

Gastrostomy tube placement after Roux-en-Y gastric bypass can be challenging, particularly in patients with dense abdominal adhesions. Novel, minimally invasive approaches are needed to access the gastric remnant when needed. We present an innovative method for gastrostomy tube placement in a patient with a retrocolic gastric bypass using a combined endoscopic ultrasound and fluoroscopy-guided approach, describing the essential technical steps of the procedure.

Innovations in therapeutic endoscopic ultrasound

“…[5,6] The authors of the current study have previously described endoscopic ultrasound (EUS)-guided insufflation of the gastric remnant in RYGB for the purposes of gastrostomy tube placement and access to the remnant stomach and subsequently developed a technique for securing gastrostomy by sutured gastropexy using laparoscopic suture passing needle. [7][8][9] In this study, the authors combined the two techniques to create a secure gastropexy so as to perform a single-session transgastric ERCP in 10 RYGB patients. The procedures were performed in the operating theatre after intravenous prophylactic antibiotics, under general anesthesia and using carbon dioxide for endoscopic insufflation.…”

EUS-assisted, fluoroscopically guided gastrostomy tube placement in patients with Roux-en-Y gastric bypass: a novel technique for access to the gastric remnant

“…1 The key principle is to safely and maximally insufflate the gastric remnant so that it reaches the abdominal wall and is easily accessible percutaneously: EUS provides a safe and straightforward access to maximally insufflate the collapsed gastric remnant. Safety and efficiency appear to be the main advantages of EUS-assisted, EUS-assisted gastrostomy tube placement in patients with Roux-en-Y gastric bypass Attam et al fluoroscopically guided G-tube placement.…”

“…Recently, our group developed a technique that involves EUS to puncture and insufflate the excluded gastric remnant to facilitate fluoroscopically guided percutaneous G-tube placement after RYGB. 1 We describe our experience with this technique in 10 consecutive patients.…”

Endoscopic solutions to challenging enteral feeding problems

“…Rueth et al [14] reported the first case of EUSassisted, fluoroscopically guided gastrostomy tube placement in a patient with Roux-en-Y gastric bypass anatomy. The same group also recently published a 10-case series [15 & ].…”