title: Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity? The use of the double-balloon enteroscope.
abstract: OBJECTIVE
  Endoscopic evaluation of the excluded stomach after Roux-en-Y gastric bypass surgery for morbid obesity is a challenge, and the pathological changes that take place in the bypassed stomach are unclear. A new double-balloon method of evaluating the bypassed stomach after Roux-en-Y gastric bypass surgery for morbid obesity is described here.
  
  
  METHODS
  This new enteroscope uses two balloons, one attached to the tip of the endoscope and the other to the distal end of the soft overtube. The procedures were carried out in six patients using the retrograde route, through the end-to-side jejunal anastomosis via the duodenobiliopancreatic limb up to the bypassed stomach.
  
  
  RESULTS
  The bypassed stomach was reached in five of six patients (83.3 %). An endoscopic appearance of atrophic gastritis was found in three patients, mild in two cases and severe in one case with intestinal metaplasia. Erosive and hemorrhagic gastritis was found in two patients.
  
  
  CONCLUSIONS
  Endoscopic evaluation of the bypassed stomach via the retrograde route after Roux-en-Y gastric bypass for morbid obesity is feasible using the double-balloon enteroscope.
authors.affiliation: Endoscopy Unit, Dept. of Gastroenterology, São Paulo University Medical School, Hospital das Clinicas, São Paulo, Brazil. paulosakai@terra.com.br
authors.forename: P
authors.initials: P
authors.lastname: Sakai
authors.forename: R
authors.initials: R
authors.lastname: Kuga
authors.forename: A V
authors.initials: AV
authors.lastname: Safatle-Ribeiro
authors.forename: J
authors.initials: J
authors.lastname: Faintuch
authors.forename: J J
authors.initials: JJ
authors.lastname: Gama-Rodrigues
authors.forename: R K
authors.initials: RK
authors.lastname: Ishida
authors.forename: C K
authors.initials: CK
authors.lastname: Furuya
authors.forename: H
authors.initials: H
authors.lastname: Yamamoto
authors.forename: S
authors.initials: S
authors.lastname: Ishioka
mesh_terms: D000713:Anastomosis, Roux-en-Y; D020776:Endoscopes, Gastrointestinal; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011182:Postoperative Care / Q000295:instrumentation*; D013270:Stomach / Q000473:pathology* / Q000601:surgery