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

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.