Endoscopic ultrasound-directed transgastric ERCP ( XXXX ) for Roux-en-Y anatomy: a novel technique.

@entity1 @entity4629
BACKGROUND: @entity1 with Roux-en-Y gastric bypass (RYGB) anatomy pose challenges when endoscopic retrograde cholangiopancreatography (ERCP) is required. Deep enteroscopy-assisted ERCP can allow pancreaticobiliary intervention in these @entity1 , but with limited success. This case series describes @entity4629 ( @entity4629 ) for @entity1 following RYGB. METHODS: @entity1 with RYGB anatomy undergoing @entity4629 at a tertiary care center were included in this prospective single-arm feasibility study. All procedures were performed in two stages. First a 16-Fr percutaneous endoscopic gastrostomy (PEG) was placed in the excluded stomach using endoscopic ultrasound (EUS) guidance. Second, ERCP was performed through the newly fashioned gastrostomy and a transcutaneous fully covered metal esophageal stent. RESULTS: Six @entity1 (5 @entity1 , 1 @entity1 ) with RYGB anatomy underwent @entity4629 . EUS-guided PEG placement was successful in all six @entity1 (100%). Antegrade ERCP was successful in all six @entity1 (100%) with the stages being separated by a mean of 5.8 days. The mean procedure times for the two stages were 81 minutes and 98 minutes. Two @entity1 (33%) had localized PEG site infections that were managed with oral antibiotics. There were no adverse events related to ERCP. CONCLUSIONS: @entity4629 is both feasible and safe to perform in RYGB @entity1 . Given the high success rates of our recent experience, we suspect that this technique can be performed as a one-stage procedure to provide a cost-effective, minimally invasive option for a common problem in a growing @entity1 population.
