Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous Gastrostomy Tube Placement to Perform Transgastrostomy Endoscopic Retrograde Cholangiopancreaticography in Patients with Roux-en-Y Anatomy

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Roux-en-Y gastric bypass (RYGB) surgery is one of the most commonly performed bariatric surgeries in the United States. Patients with prior RYGB are not amenable to conventional endoscopic retrograde cholangiopancreaticography (ERCP). Surgical gastrostomy (SG) tube placement enables transgastrostomy ERCP (TG-ERCP).

Materials and Methods

Eleven patients with RYGB anatomy received open Stamm gastrostomy after which the tract was then allowed to mature for an average of 45 days before therapeutic TG-ERCP. The success rate and procedure-related complications of both gastrostomy and ERCP were assessed.

Results

TG-ERCP was performed on eleven patients (median age 52 years, range 37–61 years) with prior RYGB and pancreatobiliary diseases. Indications for ERCP in these patients included suspected gallstone pancreatitis (n = 4), ampullary/biliary strictures (n = 5), pancreas divisum (n = 1), and common bile duct clipping as a result of RYGB surgery (n = 1). Two individuals developed post surgical complications with stomal-related infections. TG-ERCP with therapeutic intervention was successfully performed in all patients. Intervention included stone extractions (n = 11), biliary stricture dilation (n = 11), biliary sphincterotomy (n = 11), biliary (n = 3) and pancreatic (n = 1) stent placement, ampullary biopsies (n = 3), choledochoscopy (n = 1), and pseudocyst drainage (n = 1). Complications included post-ERCP pancreatitis (n = 2), post-sphincterotomy bleeding (n = 1), gastrostomy site bleed (n = 1), and gastric perforation (n = 1). The total number of ERCP sessions for the eleven patients was 15 (1 or 2 per patient). Median follow-up was 42 days (range 7–123 days).

Conclusion

Surgical open gastrostomy followed by TG-ERCP enables therapeutic intervention but is associated with significant complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Wang Y, Zhang C. Bariatric surgery to correct morbid obesity also ameliorates atherosclerosis in patients with type 2 diabetes mellitus. Am J Biomed Sci. 2009;1:56–69.

    Article  PubMed  Google Scholar 

  2. Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc. 2002;56:225–232.

    Article  PubMed  Google Scholar 

  3. Feitoza AB, Baron TH. Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part I: reconstruction without alteration of pancreaticobiliary anatomy. Gastrointest Endosc. 2001;54:743–749.

    Article  PubMed  CAS  Google Scholar 

  4. Feitoza AB, Baron TH. Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part II: postsurgical anatomy with alteration of the pancreaticobiliary tree. Gastrointest Endosc. 2002;55:75–79.

    Article  PubMed  Google Scholar 

  5. Sundbom M, Nyman R, Hedenstrom H, Gustavsson S. Investigation of the excluded stomach after Roux-en-Y gastric bypass. Obes Surg. 2001;11:25–27.

    Article  PubMed  CAS  Google Scholar 

  6. Ferrucci JT Jr, Mueller PR, Harbin WP. Percutaneous transhepatic biliary drainage: technique, results, and applications. Radiology. 1980;135:1–13.

    PubMed  Google Scholar 

  7. Peters M, Papasavas PK, Caushaj PF, Kania RJ, Gagne DJ. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for benign common bile duct stricture after Roux-en-Y gastric bypass. Surg Endosc. 2002;16:1106.

    Article  PubMed  CAS  Google Scholar 

  8. Mergener K, Kozarek RA, Traverso LW. Intraoperative transjejunal ERCP: case reports. Gastrointest Endosc. 2003;58:461–463.

    PubMed  Google Scholar 

  9. Dellon ES, Kohn GP, Morgan DR, Grimm IS. Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior Roux-en-Y anastomosis. Dig Dis Sci. 2009;54:1798–1803.

    Article  PubMed  Google Scholar 

  10. Mehdizadeh S, Ross A, Gerson L, et al. What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. Gastrointest. Endosc. 2006;64:740–750.

    Article  PubMed  Google Scholar 

  11. Emmett DS, Mallat DB. Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series. Gastrointest Endosc. 2007;66:1038–1041.

    Article  PubMed  Google Scholar 

  12. Wang AY, Sauer BG, Behm BW, et al. Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy. Gastrointest Endosc. 2010;71:641–649.

    Article  PubMed  Google Scholar 

  13. Baron TH, Vickers SM. Surgical gastrostomy placement as access for diagnostic and therapeutic ERCP. Gastrointest Endosc. 1998;48:640–641.

    Article  PubMed  CAS  Google Scholar 

  14. Baron TH, Chahal P, Ferreira LE. ERCP via mature feeding jejunostomy tube tract in a patient with Roux-en-Y anatomy (with video). Gastrointest Endosc. 2008;68:189–191.

    Article  PubMed  Google Scholar 

  15. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.

    Article  PubMed  CAS  Google Scholar 

  16. Elton E, Hanson BL, Qaseem T, Howell DA. Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc. 1998;47:62–67.

    Article  PubMed  CAS  Google Scholar 

  17. Gutierrez JM, Lederer H, Krook JC, Kinney TP, Freeman ML, Jensen EH. Surgical gastrostomy for pancreatobiliary and duodenal access following Roux en Y gastric bypass. J Gastrointest Surg. 2009;13:2170–2175.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA

    Bezawit Tekola, Andrew Y. Wang, Madhuri Ramanath, Brent Burnette, Kristi Ellen, Bryan G. Sauer & Michel Kahaleh

  2. Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA

    Bruce D. Schirmer & Peter T. Hallowell

  3. Division of Gastroenterology and Hepatology, University of Virginia Health System, Box 800708, Charlottesville, VA, 22908, USA

    Michel Kahaleh

Authors
  1. Bezawit Tekola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Y. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Madhuri Ramanath
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brent Burnette
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristi Ellen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bruce D. Schirmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter T. Hallowell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bryan G. Sauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michel Kahaleh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel Kahaleh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tekola, B., Wang, A.Y., Ramanath, M. et al. Percutaneous Gastrostomy Tube Placement to Perform Transgastrostomy Endoscopic Retrograde Cholangiopancreaticography in Patients with Roux-en-Y Anatomy. Dig Dis Sci 56, 3364–3369 (2011). https://doi.org/10.1007/s10620-011-1743-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-011-1743-6

Keywords

Search

Navigation