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...
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Published in | Gastrointestinal endoscopy Vol. 74; no. 3; pp. 677 - 682 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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Maryland heights, MO
Mosby, Inc
01.09.2011
Elsevier |
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Abstract | 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. |
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AbstractList | 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. 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. To describe a novel technique that uses EUS to insufflate the excluded gastric remnant for fluoroscopically guided percutaneous gastrostomy placement. Retrospective study. University hospital. Ten patients who required gastrostomy placement after Roux-en-Y gastric bypass. 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. Feasibility, safety, and efficacy of EUS-assisted, fluoroscopically guided gastrostomy tube placement. Technical success of EUS-assisted gastrostomy was achieved in 9 of 10 patients(90%). There were no complications. Single-institution study, small sample size. 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. BACKGROUNDAccess 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.OBJECTIVETo describe a novel technique that uses EUS to insufflate the excluded gastric remnant for fluoroscopically guided percutaneous gastrostomy placement.DESIGNRetrospective study.SETTINGUniversity hospital.PATIENTSTen patients who required gastrostomy placement after Roux-en-Y gastric bypass.INTERVENTIONSEUS 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 MEASUREMENTSFeasibility, safety, and efficacy of EUS-assisted, fluoroscopically guided gastrostomy tube placement.RESULTSTechnical success of EUS-assisted gastrostomy was achieved in 9 of 10 patients(90%). There were no complications.LIMITATIONSSingle-institution study, small sample size.CONCLUSIONSEUS-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. |
Author | Ikramuddin, Sayeed, MD Attam, Rajeev, MD Freeman, Martin, MD Leslie, Daniel, MD Andrade, Rafael, MD |
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Keywords | 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 |
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Snippet | Background Access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass for gastrostomy tube placement or therapeutic endoscopy is a... Access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass for gastrostomy tube placement or therapeutic endoscopy is a technical... BACKGROUNDAccess to the excluded gastric remnant in patients after Roux-en-Y gastric bypass for gastrostomy tube placement or therapeutic endoscopy is a... |
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SubjectTerms | 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 |
Title | EUS-assisted, fluoroscopically guided gastrostomy tube placement in patients with Roux-en-Y gastric bypass: a novel technique for access to the gastric remnant |
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