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Endoscopy 2015; 47(07): 646-649
DOI: 10.1055/s-0034-1391124
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

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
1   Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, United States
,
Daniel Leslie
2   Division of Minimally Invasive Gastrointestinal Surgery, University of Minnesota, Minneapolis, United States
,
Mustafa A. Arain
1   Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, United States
,
Martin L. Freeman
1   Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, United States
,
Sayeed Ikramuddin
2   Division of Minimally Invasive Gastrointestinal Surgery, University of Minnesota, Minneapolis, United States
› Author Affiliations
Further Information

Publication History

submitted: 30 June 2014

accepted after revision: 14 October 2014

Publication Date:
15 January 2015 (online)

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Video Comment on Attam R et al.Endoscopy 2015; 47(07): v12-v12
DOI: 10.1055/s-0034-1392469

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.

 

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