Hakim Seifeldin, Reddy Srinivas R Rami, Batke Mihaela, Polidori Gregg, Cappell Mitchell S
Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, MI 48073, United States.
World J Gastrointest Endosc. 2017 Oct 16;9(10):521-528. doi: 10.4253/wjge.v9.i10.521.
The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy (EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass (RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status post RYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.
在接受Roux-en-Y胃旁路术（RYGB）的患者中，由于在食管胃十二指肠镜检查（EGD）时难以插入术后旷置的胃和十二指肠近端，胃或十二指肠病变的诊断及内镜治疗机会可能会在EGD检查时被错过。本文报告了2例因病态肥胖接受RYGB手术10或11年后出现急性上消化道出血的病例，其中EGD检查因未能插入旷置的胃和十二指肠近端而未明确诊断，而随后的推进式小肠镜检查或单气囊小肠镜检查明确了诊断，发现了4厘米宽或5毫米宽的球部溃疡，甚至还进行了内镜治疗。这些病例报告提示，当EGD检查因未能插入这些旷置节段而无法明确诊断时，对于接受RYGB手术的急性上消化道出血患者进行内镜评估时，可考虑使用推进式小肠镜检查或单气囊小肠镜检查（若有条件）。
