EUS-guided sutured gastropexy for transgastric ERCP (ESTER) in patients with Roux-en-Y gastric bypass: a novel, single-session, minimally invasive approach

Rajeev Attam; Daniel Leslie; Mustafa A. Arain; Martin L. Freeman; Sayeed Ikramuddin

doi:10.1055/s-0034-1391124

Endoscopy, Table of Contents

Endoscopy 2015; 47(07): 646-649
DOI: 10.1055/s-0034-1391124

Innovations and brief communications

EUS-guided sutured gastropexy for transgastric ERCP (ESTER) in patients with Roux-en-Y gastric bypass: a novel, single-session, minimally invasive approach

Authors

Rajeev Attam

¹Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, United States
Daniel Leslie

²Division of Minimally Invasive Gastrointestinal Surgery, University of Minnesota, Minneapolis, United States
Mustafa A. Arain

¹Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, United States
Martin L. Freeman

¹Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, United States
Sayeed Ikramuddin

²Division of Minimally Invasive Gastrointestinal Surgery, University of Minnesota, Minneapolis, United States

Abstract

Background and study aims: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) is a challenging procedure. Available techniques are hampered by limited success, need for a separate delayed session for ERCP, potential complications, and/or invasiveness. This paper reports on a novel technique that involves endoscopic ultrasound (EUS)-guided access into the remnant stomach and sutured gastropexy for transgastric ERCP in a single combined session.

Patients and methods: A total of 10 patients with RYGB underwent transgastric ERCP using the novel technique. EUS was used to puncture the excluded stomach through the gastric pouch or jejunum, the stomach was insufflated, and a direct percutaneous gastrostomy puncture followed by sutured gastropexy was performed. ERCP was performed by passing a duodenoscope through the gastrostomy.

Results: Technical success of EUS-assisted sutured gastropexy was achieved in nine patients (90 %), with immediate, same-session ERCP in all nine. There were no adverse events.

Conclusions: EUS-assisted, fluoroscopically guided sutured gastropexy is a safe and effective method to obtain access into the excluded gastric remnant for same-session transgastric ERCP in patients with Roux-en-Y gastric bypass anatomy.

Full Text

References

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