title: Feasibility and Importance of Enteroscopy after Gastric Bypass.
abstract: Bariatric surgery has increased in popularity, with Roux-en-Y Gastric Bypass (RYGB) being one of the most frequently performed. This leads to many cases in which the stomach is removed from routine gastroscopy access, sometimes being a major source of concern. Performing enteroscopy in these patients is technically difficult. We present our experience with 24 cases in which the aim was to access the detached stomach.
  
  
  
  Retrospective analysis on RYGB enteroscopy procedures aimed to access the detached stomach. Data recorded: demographic parameters, indication, gas insufflation, time to bypass stomach, total procedure and recovery times, and endoscopic and pathological findings.
  
  
  
  This study included 24 patients who underwent RYGB in the previous 3-36 months. Indications were chronic abdominal pain, refractory anemia, or unexplainable weight loss. Detached stomach was accessed in 79% of patients. Access time ranged from 25 to 55 min. Recovery time for all procedures was 86.66 min on average and shorter with CO2insufflation (42.5 min). All detached stomachs showed macroscopic gastritis; four of them were Helicobacter pylori positive. Significant findings included three patients with jejunojejunostomy stenosis and one patient with a marginal gastrojejunal ulcer, which was later diagnosed with Signet ring cell carcinoma of the proximal anastomosis.
  
  
  
  We present the feasibility and importance of enteroscopy of the detached stomach and believe that this procedure should be performed more frequently. A high index of suspicion is needed for postoperative symptoms in order to exclude significant pathologies and reassure symptomatic patients that there is no abnormality in the bypassed stomach.
authors.affiliation: Department of Gastroenterology, Bnai-Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Golomb 47, 31048, Haifa, Israel. dr.deankeren@gmail.com.|Bariatric Gastroenterology Clinic - Gastroenterology Unit, Bnai-Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel. dr.deankeren@gmail.com.
authors.forename: Dean
authors.identifier: 0000-0001-5795-0195
authors.initials: D
authors.lastname: Keren
authors.affiliation: Department of General Surgery, Bnai-Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Golomb 47, 31048, Haifa, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Madi
authors.affiliation: Department of General Surgery, Bnai-Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Golomb 47, 31048, Haifa, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Matter
authors.affiliation: Division of Advanced Laparoscopic and Bariatric Surgery, Department of General Surgery, Rambam Healthcare Campus and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Assalia
authors.affiliation: Department of Gastroenterology, Bnai-Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Golomb 47, 31048, Haifa, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Rainis
mesh_terms: D000328:Adult; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*
keywords: Bariatric surgery; Gastric bypass; Remnant stomach; Retrograde enteroscopy