TY - JOUR
T1 - Novel approach to therapeutic ERCP after long-limb Roux-en-Y gastric bypass surgery using transgastric self-expandable metal stents
T2 - Experimental outcomes and first human case study (with videos)
AU - Baron, Todd H.
AU - Song, Louis M.Wong Kee
AU - Ferreira, Lincoln E.V.V.
AU - Smyrk, Thomas C.
N1 - Funding Information:
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Dr. Baron: research support from Boston Scientific and Cook Endoscopy and funding from Fujinon. Dr. Song: consultant to Boston Scientific and research support from Fujinon. The other authors disclosed no financial relationships relevant to this publication.
Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/6
Y1 - 2012/6
N2 - 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.
AB - 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.
KW - BAE
KW - DBE
KW - PEG
KW - RPEG
KW - RYGB
KW - Roux-en-Y gastric bypass
KW - SEMS
KW - balloon-assisted enteroscopy
KW - double-balloon enteroscopy
KW - percutaneous endoscopic gastrostomy
KW - retrograde percutaneous endoscopic gastrostomy
KW - self-expandable metal stent
UR - http://www.scopus.com/inward/record.url?scp=84861512881&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84861512881&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2012.02.026
DO - 10.1016/j.gie.2012.02.026
M3 - Article
C2 - 22624815
AN - SCOPUS:84861512881
SN - 0016-5107
VL - 75
SP - 1258
EP - 1263
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 6
ER -