Details

Autor(en) / Beteiligte

• Baron, Todd H., MD
• Song, Louis M. Wong Kee, MD
• Ferreira, Lincoln E.V.V., MD
• Smyrk, Thomas C., MD

Titel

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)

Ist Teil von

• Gastrointestinal endoscopy, 2012-06, Vol.75 (6), p.1258-1263

Ort / Verlag

Maryland heights, MO: Mosby, Inc

Erscheinungsjahr

2012

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.