title: EUS-assisted, fluoroscopically guided gastrostomy tube placement in patients with Roux-en-Y gastric bypass: a novel technique for access to the gastric remnant.
abstract: BACKGROUND
  Access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass for gastrostomy tube placement or therapeutic endoscopy is a technical challenge. Available techniques include interventional radiology-placed gastrostomy, deep enteroscopy, and surgical gastrostomy; however, these techniques are hampered by complications, technical complexity, or invasiveness.
  
  
  OBJECTIVE
  To describe a novel technique that uses EUS to insufflate the excluded gastric remnant for fluoroscopically guided percutaneous gastrostomy placement.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Ten patients who required gastrostomy placement after Roux-en-Y gastric bypass.
  
  
  METHODS
  EUS was used to puncture the excluded stomach through the gastric pouch or jejunum. The stomach was insufflated, and a direct percutaneous gastrostomy placed under fluoroscopic guidance in the distended stomach.
  
  
  METHODS
  Feasibility, safety, and efficacy of EUS-assisted, fluoroscopically guided gastrostomy tube placement.
  
  
  RESULTS
  Technical success of EUS-assisted gastrostomy was achieved in 9 of 10 patients(90%). There were no complications.
  
  
  CONCLUSIONS
  Single-institution study, small sample size.
  
  
  CONCLUSIONS
  EUS-assisted, fluoroscopically guided gastrostomy tube placement may be a safe and feasible technique to obtain enteral access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass at specialized centers.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minneapolis, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Attam
authors.forename: Daniel
authors.initials: D
authors.lastname: Leslie
authors.forename: Martin
authors.initials: M
authors.lastname: Freeman
authors.forename: Sayeed
authors.initials: S
authors.lastname: Ikramuddin
authors.forename: Rafael
authors.initials: R
authors.lastname: Andrade
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D016145:Endoscopy, Digestive System; D019160:Endosonography; D004750:Enteral Nutrition; D005471:Fluoroscopy; D015390:Gastric Bypass; D018530:Gastric Stump / Q000000981:diagnostic imaging* / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007327:Insufflation; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult