EUS-guided sutured gastropexy for transgastric ERCP (ESTER) in patients with Roux-en-Y gastric bypass: A novel, single-session, minimally invasive approach

Rajeev Attam, Daniel Leslie, Mustafa A. Arain, Martin L. Freeman, Sayeed Ikramuddin

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

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

Original languageEnglish (US)
Pages (from-to)646-649
Number of pages4
JournalEndoscopy
Volume47
Issue number7
DOIs
StatePublished - Jul 29 2015

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