Endoscopic evaluation of the defunctionalized stomach by using ShapeLock technology (with video).
BACKGROUND
Patients with Roux-en-Y gastric bypass (RYGB) present a unique problem if they require diagnostic or therapeutic interventions for which the pancreatobiliary limb or the defunctionalized stomach must be accessed. Novel shape-locking guides have been reported in the literature to reduce looping during colonoscopy, and a new guide is now available to assist with enteroscopy.


OBJECTIVE
To use ShapeLock technology to permit evaluation of the defunctionalized stomach.


METHODS
Observational case series.


METHODS
Tertiary-care center.


METHODS
Nine patients with a history of RYGB referred for repeat endoscopic evaluation after initial enteroscopy failed to reach the excluded stomach.


METHODS
After achieving appropriate levels of sedation, a standard enteroscope was back-loaded with the ShapeLock enteroscopy guide and was inserted through the mouth. The device was moved through the gastrojejunal (GJ) anastomosis, along the Roux limb, and into the distal pancreatobiliary limb. The device was then locked, which allowed the enteroscope to be advanced to the defunctionalized stomach.


RESULTS
The ShapeLock guide was able to be advanced to the excluded stomach and perform a thorough examination of the pancreatobiliary limb in 8 of 9 patients, without complications. In 1 patient, the diameter of the GJ anastomosis prevented passage of the device.


CONCLUSIONS
The ShapeLock enteroscopy guide can allow access to the upper-GI tract in patients after RYGB, provided the GJ anastomosis is of adequate diameter. This study suggested that the technique is safe and has the potential to allow therapeutic interventions in the defunctionalized stomach and duodenum, including ERCP.
Pai
Reina D
RD
Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Carr-Locke
David L
DL
Thompson
Christopher C
CC
D015746:Abdominal Pain / Q000209:etiology; D014670:Ampulla of Vater; D000713:Anastomosis, Roux-en-Y; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D003137:Common Bile Duct Diseases / Q000175:diagnosis*; D020698:Duodenoscopes; D004867:Equipment Design; D005471:Fluoroscopy; D015390:Gastric Bypass; D005756:Gastritis / Q000175:diagnosis; D005773:Gastroscopy; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013272:Stomach Diseases / Q000175:diagnosis*