The sand dollar sign: a reliable EUS image to identify the excluded stomach during EUS-guided gastrogastrostomy

Siddiki, Hassan; Baron, Todd H.

doi:10.1016/j.gie.2018.02.025

Cited by 8 publications

(5 citation statements)

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“…The other way to perform PATENT is the EUS-guided technique, but few data are available in the literature about this EUS-guided gastrostomy application and they are mainly pilot studies [ 76 , 77 ]. The EUS-PATENT technique consists of the ultrasound identification of the remnant stomach through the gastric pouch (ultrasound visualization of the sand dollar sign helps to correctly identify the excluded stomach [ 78 ]), EUS-guided puncture of remnant cavity and filling it with contrast and carbon dioxide. These maneuvers are necessary to percutaneously detect the excluded stomach in order to correctly insert the devices for PEG insertion.…”

Section: Resultsmentioning

confidence: 99%

Biliopancreatic Endoscopy in Altered Anatomy

Tarantino

Rizzo

2021

Medicina

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Background and Objectives: Anatomical post-surgical alterations of the upper gastrointestinal (GI) tract have always been challenging for performing diagnostic and therapeutic endoscopy, especially when biliopancreatic diseases are involved. Esophagectomy, gastrectomy with various reconstructions and pancreaticoduodenectomy are among the most common surgeries causing upper GI tract alterations. Technological improvements and new methods have increased the endoscopic success rate in these patients, and the literature has been rapidly increasing over the past few years. The aim of this systematic review is to identify evidence on the available biliopancreatic endoscopic techniques performed in the altered post-surgical anatomy of upper GI tract. Materials and Methods: We performed a systematic search of PubMed, MEDLINE, Cochrane Library, and SCOPUS databases. Study-level variables extracted were the last name of the first author, publication year, study design, number of patients, type of post-surgical anatomical alteration, endoscopic technique, success rate and endoscopic-related adverse events. Results: Our primary search identified 221 titles, which was expanded with studies after the citation search. The final full-text review process identified 52 articles (31 retrospective studies, 8 prospective studies and 13 case reports). We found several different techniques developed over the years for biliopancreatic diseases in altered anatomy, in order to perform both endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). They included enteroscopy-assisted ERCP (double and single balloon enteroscopy-ERCP, spiral enteroscopy-ERCP) laparoscopic assisted ERCP, EUS-Directed transgastric ERCP, EUS-directed transgastric intervention, gastric access temporary for endoscopy, and percutaneous assisted trans prosthetic endoscopic therapy. The success rate was high (most of the techniques showed a success rate over 90%) and a low rate of adverse events were reported. Conclusions: We suggest the considerationof the novel techniques when approaching patients with altered anatomy who require biliopancreatic endoscopy, focusing on the surgery type, success rate and adverse events reported in the literature.

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Section: Resultsmentioning

confidence: 99%

Biliopancreatic Endoscopy in Altered Anatomy

Tarantino

Rizzo

2021

Medicina

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“…In each of the procedures, a 20-mm-diameter lumen-apposing metal stent (LAMS) was deployed under EUS guidance to allow access from the gastric remnant or proximal jejunum to the excluded stomach. The excluded stomach lumen is typically collapsed and is identified endosonographically by the so-called ‘sand dollar sign’ ( 9 ). Standard FNA needle puncture access is followed by injection of saline-contrast solution with or without methylene blue to expand the target for access with the electrocautery enhanced delivery device and placement of LAMS.…”

Section: Resultsmentioning

confidence: 99%

Living on the EDGE: Canadian Experience With EUS-directed Transgastric ERCP (EDGE) in Patients With Roux-en-Y Gastric Bypass Anatomy

Barclay

Jain

Ferland

et al. 2021

Journal of the Canadian Association of Gastroenterology

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Introduction Roux-en-Y gastric bypass (RYGB) surgery imposes anatomic barriers to endoscopic retrograde cholangiopancreatography (ERCP). Potential options for biliary access in these patients include laparoscopic-assisted ERCP or balloon enteroscopy. However, these approaches require specialized equipment and/or operating room personnel and are associated with high rates of failure and adverse events compared to conventional ERCP. A recently described technique, EDGE, is an endoscopic approach which involves accessing the excluded stomach to facilitate ERCP. Objective The objective of this study is to describe the results of EDGE procedures performed in Canada. Methods Data were collected from patient cases who had undergone an EDGE procedure across centers in Canada. All patients had a history of RYGB bariatric surgery. In each procedure, a 20-mm diameter lumen-apposing metal stent (LAMS) was deployed under EUS guidance to allow access from the gastric remnant/proximal jejunum to the excluded stomach. Subsequently, during a separate procedure, a duodenoscope was passed through the LAMS to perform ERCP. Following ERCP, the LAMS was replaced with a pigtail stent or APC was used to facilitate closure of the gastro-jejunal/gastro-gastric fistula. Results The indication for EDGE in the seven included cases was for the treatment of choledocholithiasis (six) or gallstone pancreatitis (one). The technical success rate of the EDGE procedure in these cases was 100%. Clinical success, defined by normalization of bilirubin and symptomatic relief, was observed in all cases. There were no adverse events reported. Conclusion The results of this series support EDGE as a safe and minimally invasive approach to biliary access and therapy in patients with previous RYGB surgery.

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“…For gastrogastrostomy creation, the echoendoscope is positioned in the gastric pouch, or less frequently the jejunal Roux limb, to identify the excluded stomach (often described as having a notable “sand dollar” appearance 29 [ Fig. 3a ]).…”

Section: Luminal Access Permitting Ercpmentioning

confidence: 99%

“…13 Recent systematic reviews and meta-analyses have also reported comparable technical and clinical success rates for EUS-CDS and EUS-HGS. 3,14,15 Although the choice of approach may be selected based on patient anatomy or endoscopist preference, the significantly lower AE rate found with EUS-CDS compared with EUS-HGS by Hedjoudje et al (20%, 95% confidence interval [CI]: [16][17][18][19][20][21][22][23][24][25] vs. 29%, 95% CI [24][25][26][27][28][29][30][31][32][33][34], p ¼ 0.01) suggests that EUS-CDS may be the safer approach when compared with EUS-HGS.…”

Section: Direct Biliary Drainagementioning

confidence: 99%

Endoscopic Approaches to the Management of Biliary Tract Pathology: The Use of Therapeutic Endoscopic Ultrasound

Hosmer

2022

Digestive Disease Interventions

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Endoscopic ultrasound–guided biliary drainage (EUS-BD) procedures aid in the treatment of biliary diseases and can be considered in the setting of failed conventional endoscopic retrograde cholangiopancreatography, surgically altered gastrointestinal or biliary anatomy with an inaccessible major papilla, malignant obstruction precluding biliary access, or a contraindication to percutaneous biliary access. Although device innovations and technical improvements continue to advance the field of therapeutic EUS, further investigations are required. The purpose of this review is to highlight recent literature on the indications, techniques, capabilities, and outcomes of EUS-BD. Recent literature has demonstrated that EUS-BD is a safe and effective treatment option in the management of biliary diseases. Current studies have assessed the various EUS-BD techniques and have attempted to clarify the optimal treatment algorithm for those with complex biliary pathologies.

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The sand dollar sign: a reliable EUS image to identify the excluded stomach during EUS-guided gastrogastrostomy

Cited by 8 publications

References 0 publications

Biliopancreatic Endoscopy in Altered Anatomy

Biliopancreatic Endoscopy in Altered Anatomy

Living on the EDGE: Canadian Experience With EUS-directed Transgastric ERCP (EDGE) in Patients With Roux-en-Y Gastric Bypass Anatomy

Endoscopic Approaches to the Management of Biliary Tract Pathology: The Use of Therapeutic Endoscopic Ultrasound

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