title: Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass.
abstract: Background and aimsEndoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Roux-en-Y gastric bypass (RYGB) is technically challenging. We describe our multicenter experience using lumen-apposing metal stents (LAMSs) to create an endoscopic ultrasound-guided transgastric fistula (EUS-TG) to facilitate peroral ERCP in these patients.Patients and methodsThirteen patients with RYGB who underwent EUS-TG at three tertiary centers were included. EUS was used to guide puncture of the excluded stomach from the gastric pouch or jejunum; a LAMS was placed across the transgastric fistula. ERCP was performed via a duodenoscope passed through the LAMS.ResultsThe technical success of EUS-TG was 100 % (13/13). ERCP through the LAMS was successful and clinical success was achieved in all patients. LAMS dislodgement during ERCP occurred in two patients and the stent was successfully repositioned without sequelae. After removal of the LAMS, the fistula was closed in 92 % of patients, either by endoscopic closure devices or argon plasma coagulation. None of the patients experienced procedure-related adverse events.ConclusionEUS-TG is an effective and safe method of accessing the excluded stomach and performing ERCP in patients with RYGB.
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.affiliation: Advanced Therapeutic Endoscopy Center, Borland Groover Clinic, Jacksonville, Florida, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Nieto
authors.affiliation: Department of Surgical Gastroenterology, Aarhus University Hospital, Denmark.
authors.forename: Rastislav
authors.initials: R
authors.lastname: Kunda
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Yen-I
authors.initials: YI
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Majidah
authors.initials: M
authors.lastname: Bukhari
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mohamad Hassan
authors.initials: MH
authors.lastname: El Zein
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Renata P
authors.initials: RP
authors.lastname: Bueno
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Gulara
authors.initials: G
authors.lastname: Hajiyeva
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Ismail
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Yamile Haito
authors.initials: YH
authors.lastname: Chavez
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D018084:Ultrasonography, Interventional / Q000009:adverse effects