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Gastrointest Endosc. 2012 Jun;75(6):1258-63. doi: 10.1016/j.gie.2012.02.026.

Novel approach to therapeutic ERCP after long-limb Roux-en-Y gastric bypass surgery using transgastric self-expandable metal stents: experimental outcomes and first human case study (with videos).

Author information

1
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA. baron.todd@mayo.edu

Abstract

BACKGROUND:

ERCP in Roux-en-Y gastric bypass (RYGB) patients is challenging. Balloon-assisted enteroscopy (BAE) allows access to the excluded stomach with creation of a percutaneous endoscopic gastrostomy (PEG). Transgastric self-expandable metal stent (SEMS) placement may allow antegrade ERCP in 1 session.

OBJECTIVE:

To determine the feasibility of transgastric endoscopy and ERCP through a newly created PEG augmented by SEMS placement.

DESIGN:

Prospective live animal study; human case report.

SETTINGS:

Animal laboratory and endoscopy units, tertiary care medical center.

SUBJECTS:

Nine domestic pigs; 1 patient.

INTERVENTIONS:

PEG tract with SEMS placement; transgastric endoscopy through SEMS.

MAIN OUTCOME MEASUREMENTS:

Technical success, feasibility of transgastric endoscopy.

RESULTS:

Successful SEMS deployment was achieved in 9 of 9 animals. The stent was removed in 6 animals; 3 were killed within 24 hours (group A) and 3 were killed 1 week later (group B). In 3 animals, stents remained in place, they were killed 9 to 15 days later (group C). Duodenoscopy was difficult in 1 animal from group A resulting in stent dislodgment. Peristomal infection occurred in 1 animal in group B. In group C, 1 stent was buried subcutaneously and 1 completely migrated out. Necropsy showed no peritoneal fluid or peritonitis in any animal. In the 1 patient, BAE-assisted PEG and SEMS placement in the excluded stomach allowed antegrade ERCP and biliary sphincterotomy without adverse events.

LIMITATIONS:

Small number of subjects.

CONCLUSIONS:

Performance of PEG with immediate SEMS placement allows for antegrade transgastric ERCP during 1 procedure. With the use of BAE, retrograde PEG/SEMS in excluded stomach allows therapeutic ERCP without need for surgery.

PMID:
22624815
DOI:
10.1016/j.gie.2012.02.026
[Indexed for MEDLINE]

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