title: The concept of laparoscopy-assisted pancreatobiliary EUS (LAP-EUS).
abstract: BACKGROUND
  While laparoscopy-assisted endoscopic retrograde cholangiopancreatography can be performed for the diagnosis and management of pancreaticobiliary diseases in patients with Roux-en-Y (RY) anatomy; the technical feasibility of performing laparoscopy-assisted endoscopic ultrasound (EUS) is unknown.
  
  
  METHODS
  In this report, we describe the technique for performing laparoscopy-assisted EUS in two patients with RY gastric bypass anatomy who presented with obstructive jaundice, abnormal liver function tests, and dilated biliary tree.
  
  
  RESULTS
  While the examination was normal in one patient, EUS-guided fine needle aspiration of pancreatic head mass revealed adenocarcinoma in the other.
  
  
  CONCLUSIONS
  Laparoscopic assisted EUS examination including FNA is feasible in Roux-en-Y surgical anatomy.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA. j1ramesh@gmail.com
authors.forename: Jayapal
authors.initials: J
authors.lastname: Ramesh
authors.forename: John
authors.initials: J
authors.lastname: Christein
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic; D019160:Endosonography / Q000379:methods*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008111:Liver Function Tests; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery*