title: EUS-guided sutured gastropexy for transgastric ERCP (ESTER) in patients with Roux-en-Y gastric bypass: a novel, single-session, minimally invasive approach.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) is a challenging procedure. Available techniques are hampered by limited success, need for a separate delayed session for ERCP, potential complications,and/or invasiveness. This paper reports on a novel technique that involves endoscopic ultrasound(EUS)-guided access into the remnant stomach and sutured gastropexy for transgastric ERCP in a single combined session.
  
  
  METHODS
  A total of 10 patients with RYGB underwent transgastric ERCP using the novel technique. EUS was used to puncture the excluded stomach through the gastric pouch or jejunum,the stomach was insufflated, and a direct percutaneous gastrostomy puncture followed by sutured gastropexy was performed. ERCP was performed by passing a duodenoscope through the gastrostomy.
  
  
  RESULTS
  Technical success of EUS-assisted sutured gastropexy was achieved in nine patients (90 %),with immediate, same-session ERCP in all nine.There were no adverse events.
  
  
  CONCLUSIONS
  EUS-assisted, fluoroscopically guided sutured gastropexy is a safe and effective method to obtain access into the excluded gastric remnant for same-session transgastric ERCP inpatients with Roux-en-Y gastric bypass anatomy.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, United States.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Attam
authors.affiliation: Division of Minimally Invasive Gastrointestinal Surgery, University of Minnesota, Minneapolis, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Leslie
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, United States.
authors.forename: Mustafa A
authors.initials: MA
authors.lastname: Arain
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, United States.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.affiliation: Division of Minimally Invasive Gastrointestinal Surgery, University of Minnesota, Minneapolis, United States.
authors.forename: Sayeed
authors.initials: S
authors.lastname: Ikramuddin
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D020698:Duodenoscopes; D019160:Endosonography; D005260:Female; D015390:Gastric Bypass; D059485:Gastropexy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013536:Suture Techniques; D018084:Ultrasonography, Interventional