title: Use of double-balloon enteroscopy to perform PEG in the excluded stomach after Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Because 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).
  
  
  OBJECTIVE
  To perform PEG in the excluded stomach by using DBE.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Single, North American tertiary-care center.
  
  
  METHODS
  Individuals with postoperative complications after RYGB that requires radiographic examination of the excluded stomach and the pancreaticobiliary limb, or enteral feeding.
  
  
  METHODS
  Performance of PEG within the excluded stomach by using DBE.
  
  
  METHODS
  Ability to perform PEG-procedure-related complications and resultant management changes.
  
  
  RESULTS
  PEG 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.
  
  
  CONCLUSIONS
  Small sample size, single-center experience.
  
  
  CONCLUSIONS
  PEG 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.
authors.affiliation: Section of Endoscopy and Therapeutics, The University of Chicago Hospitals, 5841 S. Maryland Ave. MC 4076, Chicago, IL 60607, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Ross
authors.forename: Carol
authors.initials: C
authors.lastname: Semrad
authors.forename: John
authors.initials: J
authors.lastname: Alverdy
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
authors.forename: Charles
authors.initials: C
authors.lastname: Dye
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy; D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D002404:Catheterization; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005774:Gastrostomy; D006801:Humans; D008875:Middle Aged; D009656:North America; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D012107:Research Design; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss