Use of double-balloon enteroscopy to perform PEG in the excluded stomach after Roux-en-Y gastric bypass

BackgroundBecause of postoperative complications, patients who have undergone Roux-en-Y gastric bypass (RYGB) for weight loss may require radiographic investigation of the pancreaticobiliary limb or enteral feeding. Gastrostomy-tube placement into the excluded stomach for these indications is typically performed surgically or via fluoroscopic or US guidance; PEG has not been reported as being performed for this purpose. Successful examination of the excluded stomach after RYGB has been reported when using double-balloon enteroscopy (DBE).ObjectiveTo perform PEG in the excluded stomach by using DBE.DesignRetrospective review.SettingSingle, North American tertiary-care center.PatientsIndividuals with postoperative complications after RYGB that requires radiographic examination of the excluded stomach and the pancreaticobiliary limb, or enteral feeding.InterventionsPerformance of PEG within the excluded stomach by using DBE.Main Outcome MeasurementsAbility to perform PEG-procedure–related complications and resultant management changes.ResultsPEG was successfully performed by using DBE in 3 of 4 patients with postoperative complications after RYGB. In 2 of the cases, the results of radiographic studies performed with contrast administration through the gastrostomy tube led to significant operative management changes. In the third case, preoperative enteral nutrition was provided by using a gastrostomy tube. PEG placement was not possible in the fourth case because of the lack of abdominal transillumination. Major complications were not observed.LimitationsSmall sample size, single-center experience.ConclusionsPEG placement in the excluded stomach after RYGB by using DBE was safe, technically feasible, and led to management changes in patients in whom it was performed. This procedure should be added to the growing list of indications for DBE.