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

• Published in: Gastrointestinal endoscopy Vol. 74; no. 3; pp. 677 - 682
• Main Authors: Attam, Rajeev, MD, Leslie, Daniel, MD, Freeman, Martin, MD, Ikramuddin, Sayeed, MD, Andrade, Rafael, MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.09.2011; Elsevier
• Subjects: Adult; Aged; Anastomosis, Roux-en-Y; Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Endoscopy, Digestive System; Endosonography; Enteral Nutrition; Fluoroscopy; Gastric Bypass; Gastric Stump - diagnostic imaging; Gastric Stump - surgery; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrostomy - methods; Humans; Insufflation; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Middle Aged; Retrospective Studies; Young Adult; G-tube; Roux-en-Y gastric bypass; gastrostomy tube; RYGB; Sonography; Gastrostomy; Human; Stomach; Treatment; Endoscopic route; Surgery; Endoscopic ultrasonography; Echography; Roux en Y loop; Technique
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.05.018

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.