Percutaneous computed tomography-guided gastric remnant access after laparoscopic Roux-en-Y gastric bypass.
BACKGROUND
The bypassed portion of the stomach is difficult to access and evaluate after Roux-en-Y gastric bypass. Access to the excluded stomach may be needed for nutritional support or decompression owing to acute distension and obstruction. We report our experience with percutaneous, computed tomography (CT)-guided gastrostomy tube placement into the gastric remnant after laparoscopic Roux-en-Y gastric bypass (LRYGB).


METHODS
Of 569 consecutive LRYGB procedures performed, 9 patients underwent successful percutaneous, CT-guided gastrostomy placement. One additional patient was referred from another facility. We reviewed the indications, interval from surgery to the intervention, interval to removal, complications, and success or outcome of the procedure in our patient population.


RESULTS
Ten patients underwent percutaneous, CT-guided gastric remnant gastrostomy tube placement. The indications included distended gastric remnant in 6, nutritional access in 4, and remnant drainage after leak in 1. Of the 10 patients, 2 had undergone previous gastric operations. The attempt at percutaneous gastrostomy was unsuccessful in 1 additional patient, who subsequently required laparoscopic gastrostomy (success rate 91%).


CONCLUSIONS
In selected patients after LRYGB, CT-guided gastrostomy tube placement is safe and efficient. It may be used to manage complications of LRYGB, serve as a bridge to definitive surgery, or offer a convenient route for enteral nutritional support.
Goitein
David
D
Temple University School of Medicine Clinical Campus at Western Pennsylvania Hospital, Pittsburgh, Pennsylvania 15224, USA.
Gagné
Daniel J
DJ
Papasavas
Pavlos K
PK
McLean
Gordon
G
Foster
Richard G
RG
Beasley
H Scott
HS
Caushaj
Philip F
PF
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005471:Fluoroscopy; D015390:Gastric Bypass / Q000379:methods*; D018530:Gastric Stump / Q000000981:diagnostic imaging* / Q000601:surgery; D005773:Gastroscopy; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome