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Create a Free AccountProcedures - Bariatrics
Switching the switch: endoscopic reversal of a biliopancreatic diversion
Biliopancreatic diversion (also known as duodenal switch) is a complex bariatric surgery that includes a sleeve gastrectomy and long Roux-en-Y intestinal bypass. The entero-enteric anastomosis is very distal, resulting in bypass of two-thirds or more of the intestine. Patients lose weight not only because nutrients bypass most of the intestine, thereby reducing the absorption area, but also because nutrients join the biliopancreatic secretions and enzymes distally, leading to reduced digestion and absorption.Endoscopic revision of gastric bypass using plication technique: an adjustable approach
Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric surgeries worldwide.1 Despite successful weight loss after RYGB, weight regain in subsequent years is common, with nearly one-third of patients returning to their prebypass weight.2,3 Although the cause of weight regain is often multifactorial, one of the anatomic causes is dilation and increased tissue compliance of the gastrojejunal anastomosis (GJA),4 which is likely a larger contributor to weight loss than anastomosis size alone.EUS-guided jejunojejunostomy to facilitate ERCP in a patient with unique Roux-en-Y gastric bypass anatomy
Lumen-apposing metal stents (LAMSs), although initially created for draining pancreatic fluid collections, are frequently used in an “off-label” fashion. They have recently gained popularity as a means to facilitate ERCP in patients with surgically altered GI anatomy. We have previously described using LAMSs to create a temporary gastroenterostomy to facilitate ERCP in a patient with duodenal switch anatomy.1 The present case describes the use of a LAMS to enable ERCP in a patient with a history of vertical sleeve gastrectomy converted to a Roux-en-Y gastric bypass.Start of a new TREnD: TransRemnant Endoscopic Drainage for management of walled-off necrosis in a patient with Roux-en-Y gastric bypass
A 64-year-old woman with a history of Roux-en-Y gastric bypass (RYGB) was admitted to an outside hospital with severe necrotizing pancreatitis. Three weeks after her initial presentation, the patient was transferred to our hospital because of persistent abdominal pain and nausea, along with fever and worsening leukocytosis.Gastric overtube use to prevent duodenoscope loop formation during EUS-directed transgastric ERCP procedure
A patient with a history of Roux-en-Y gastric bypass surgery in 2003 and cholecystectomy in 2017 was transferred for evaluation of biliary-type abdominal pain and abnormal liver test results. Abdominal US scan demonstrated a dilated bile duct measuring 1.4 cm and choledocholithiasis (Fig. 1). Upper endoscopy confirmed normal Roux-en-Y anatomy, and an EUS-directed transgastric ERCP procedure was planned.Management of adverse events of EUS-directed transgastric ERCP procedure
Accessing the pancreatobiliary region in patients with a history of Roux-en-Y gastric bypass (RYGB) can be challenging. Traditionally, techniques such as percutaneous biliary drainage, enteroscopy-assisted ERCP, and laparoscopy-assisted ERCP have been used. However, each technique has its limitations. EUS–directed transgastric ERCP (EDGE) using a lumen-apposing metal stent (LAMS) has emerged as a novel endoscopic technique for ERCP in patients who have undergone RYGB. The aim of this case series was to highlight LAMS-related shortcomings and adverse events during the periprocedural period.Role of endoscopic vacuum therapy, internal drainage, and stents for postbariatric leaks
Therapeutic endoscopy plays a major role in the management of postbariatric anastomotic leaks, offering an effective treatment alternative to repeated surgery. In recent years, management has been moving from bridging and closing the leak’s orifice toward an approach that uses vacuum therapy or internal drainage. Our aim was to demonstrate different treatment options for the management of postbariatric leaks.Creation of a gastrogastric conduit by use of a lumen-apposing metal stent in a patient who had extensive small-bowel surgery secondary to a Peterson hernia
A 48-year-old woman underwent gastric-bypass surgery for obesity management. This was followed by the adverse event of a Peterson’s hernia. Attempts to repair the hernia failed and were complicated by extensive postoperative small-bowel ischemia. The patient underwent multiple laparotomies, right hemicolectomy, small-bowel resection with end jejunosotomy, a blind-ending esophagus into the gastric pouch, and rectal stump with mucous fistula.Duodenal endoscopic submucosal dissection and sutured defect closure across a lumen-apposing metal stent
Patients with gastric bypass anatomy face unique challenges and limited options with respect to endoscopy in the bypassed portion of the stomach and duodenum.1 Here we introduce a novel technique for EUS-guided creation of a temporary access tract and demonstrate various therapeutic interventions that can be safely and effectively performed across the access tract in the bypassed duodenum (Video 1, available online at www.VideoGIE.org ).Mitigating lumen-apposing metal stent dislodgment and allowing safe, single-stage EUS-directed transgastric ERCP
Until recently, patients with Roux-en-Y gastric bypass had the options of enteroscopy-assisted or surgery-assisted ERCP.1 However, the use of a lumen-apposing metal stent (LAMS) with EUS to create a transgastric fistula allows for ERCP with a duodenoscope (EUS-directed transgastric ERCP [EDGE]).2 However, dislodgement of the LAMS with advancement of the endoscope can result in a perforation, leading some providers to do this in 2 stages: LAMS placement followed by fistula maturation (7-14 days) and subsequent ERCP.Lumen-apposing metal stent for gastric stricture after sleeve gastrectomy
Sleeve gastrectomy is a commonly performed bariatric procedure that is complicated by stricture formation in approximately 0.5% of cases.1 Gastric sleeve surgery adverse events, which can result in strictures and leaks, are increasingly managed through a minimally invasive endoscopic approach. Surgical revision of sleeve gastrectomy is associated with significant morbidity even when performed laparoscopically.2,3 Therefore, endoscopic management is the preferred option. However, the usual endoscopic management of strictures with balloon dilation and covered esophageal stents is not always successful and may require a repeated operation.
