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

Abstract

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.

Gastric cancer after gastric bypass with fundectomy: The possibility for early diagnosis

“…For this reason, several authors have tried alternative methods to study the excluded portion of the stomach (double balloon endoscopy, percutaneous endoscopy, virtual endoscopy, laparoscopic gastrostomy), but each is technically challenging, often unsuccessfull or requires the patient to undergo surgery and is therefore performed only in case of necessity due to the onset of complications or when there is a high probability of malignancy. In any case, these procedures are never carried out at an early point in time [[20], [21], [22], [23]].…”

Gastrojejunoscopy facilitates placement of a percutaneous transgastric jejunostomy in a patient with a pancreaticoduodenectomy and multiple-failed feeding tube placements

“…Eventually, a gastrojejunostomy tube was placed utilizing percutaneous techniques with fluoroscopy assistance and gastrojejunoscopy guidance. A combined technique with fluoroscopy and endoscopy, both controlled by interventional radiology, may be useful in patients with complex postsurgical gastrointestinal anatomy who require enteral access [4] . Percutaneous endoscopy is an invaluable technique that should be added to the abdominal and interventional radiology armamentarium.…”

Resectional One Anastomosis Gastric Bypass/Mini Gastric Bypass as a Novel Option for Revision of Restrictive Procedures: Preliminary Results

“…Also, postoperative complications including bleeding, acute dilatation, and leaks, arising from the remnant stomach, were also eliminated while postoperative hospital stay compares favorably with others [ 8 , 10 , 24 – 27 ]. In the long run, the risk of cancer arising from the resected stomach with an estimated incidence of 0.03% is also discarded [ 27 – 31 ]. Notably, EBL and TWL at one year after R-OAGB/MGB exceeded those reported after revisional OAGB/MGB series [ 8 , 13 , 24 , 32 ] and even after some primary OAGB/MGB series [ 22 , 33 , 34 ].…”