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

Attam, Rajeev; Leslie, Daniel B.; Freeman, Martin L.; Ikramuddin, Sayeed; Andrade, Rafael S.

doi:10.1016/j.gie.2011.05.018

Cited by 58 publications

(41 citation statements)

References 22 publications

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“…It is appropriate to mention that there do exist other fully endoscopic, minimally invasive procedures for accessing the remnant stomach, such as percutaneous-assisted transprosthetic endoscopic therapy (PATENT) [19], EUS-assisted, fluoroscopically guided gastrostomy tube placement [20,21], and external EDGE [22,23]. PATENT consists of advancement of a duodenoscope through an esophageal self-expanding metal stent deployed within a percutaneous gastrostomy tract.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure

et al. 2017

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Background/AimsPerforming endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Rouxen-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS.MethodsAll patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection.ResultsSixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg.ConclusionsEDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure

et al. 2017

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“…Such procedures are not yet widely available outside specialized centers and, as demonstrated in the aforementioned study, require highly specialized expertise for successful completion. A more invasive but direct approach to the major papilla in patients with a Roux-en-Y gastric bypass is creation of a gastrostomy, via a surgical approach (laparoscopic or open) or percutaneously using EUS guidance, followed by ERCP through the gastrostomy port (73). In recent study of patients with a Roux-en-Y gastric bypass, biliary intervention was achieved in all patients using a surgical approach compared to only 58% of patients in whom deep enteroscopy was performed (74) with lower success in patients with a Roux limb greater than 150 cm.…”

Section: Treatment Of Biliary Complications After Roux-en-y Hepaticojmentioning

confidence: 99%

Advances in endoscopic management of biliary tract complications after liver transplantation

2013

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Biliary tract complications after liver transplantation (LT) most commonly include biliary leaks, strictures, and stone disease. Living donor recipients and donation after cardiac death recipients are at an increased risk of developing biliary complications. Biliary leaks usually occur early after transplantation, whereas strictures and stone disease occur later. The diagnosis of biliary complications relies on a combination of clinical presentation, laboratory abnormalities, and imaging modalities. Biliary leaks are usually diagnosed on the basis of bilious output from a surgical drain, fluid collections on imaging, or a cholescintigraphy scan demonstrating a leak. Magnetic resonance cholangiopancreatography (MRCP) is noninvasive, does not require the administration of an intravenous contrast agent, and provides detailed imaging of the entire biliary system both above and below the anastomosis. The latter not only helps in the diagnosis of biliary strictures and stones before patients undergo invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) but also allows treating physicians to plan the optimal treatment approach. MRCP has, therefore, replaced invasive therapeutic modalities such as ERCP as the modality of choice for the diagnosis of biliary strictures and stones. There have been significant advances in endoscopic accessories, including biliary catheters, wires, and stents, as well as endoscopic technologies such as overtube-assisted endoscopy over the last decade. These developments have resulted in almost all patients, including those with difficult strictures or altered surgical anatomies (eg, Roux-en-Y hepaticojejunostomy), being treated via an endoscopic approach with percutaneous transhepatic cholangiography, which is more invasive and associated with significant morbidity, with surgery being reserved for a small minority of patients. Advances in the diagnosis and endoscopic management of patients with biliary complications after LT are discussed in this review.

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“…More recently, an EUS-guided approach by interventional gastroenterologists can be employed [9]. CT- or EUS-guided fine-needle aspiration can be used if the mass in the excluded stomach is seen with these imaging techniques; however, this is often not the case.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopy to diagnose malignancy in gastric outlet obstruction of excluded stomach after gastric bypass

Ahmad

Rubin

Kwong

2017

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Gastric cancer in the excluded stomach after Roux-en-Y gastric bypass is a rare finding and most reported diagnoses are made via surgery. Endoscopic access to the excluded stomach is difficult, even with balloon-assisted enteroscopy. We present the case of a 74-year-old woman with malignant gastric outlet obstruction of the excluded stomach, 41 years after Roux-en-Y gastric bypass. Minimally invasive access to the excluded stomach was obtained by placement of a percutaneous gastrostomy tube, followed by insertion of a pediatric gastroscope through the gastrostomy tube tract. This novel approach provides minimally invasive access to the excluded stomach in patients with high suspicion of pathology in the excluded stomach, when balloon-assisted enteroscopy is not technically feasible or available.

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

Cited by 58 publications

References 22 publications

Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure

Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure

Advances in endoscopic management of biliary tract complications after liver transplantation

Percutaneous endoscopy to diagnose malignancy in gastric outlet obstruction of excluded stomach after gastric bypass

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