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

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.