TY - JOUR
T1 - EUS-guided sutured gastropexy for transgastric ERCP (ESTER) in patients with Roux-en-Y gastric bypass
T2 - A novel, single-session, minimally invasive approach
AU - Attam, Rajeev
AU - Leslie, Daniel
AU - Arain, Mustafa A.
AU - Freeman, Martin L.
AU - Ikramuddin, Sayeed
PY - 2015/7/29
Y1 - 2015/7/29
N2 - Background and study aims: 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. Patients and 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 in patients with Roux-en-Y gastric bypass anatomy
AB - Background and study aims: 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. Patients and 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 in patients with Roux-en-Y gastric bypass anatomy
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U2 - 10.1055/s-0034-1391124
DO - 10.1055/s-0034-1391124
M3 - Article
C2 - 25590176
AN - SCOPUS:84933038748
SN - 0013-726X
VL - 47
SP - 646
EP - 649
JO - Endoscopy
JF - Endoscopy
IS - 7
ER -