Digestive Diseases and Sciences

, Volume 56, Issue 11, pp 3364–3369

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

  • Bezawit Tekola
  • Andrew Y. Wang
  • Madhuri Ramanath
  • Brent Burnette
  • Kristi Ellen
  • Bruce D. Schirmer
  • Peter T. Hallowell
  • Bryan G. Sauer
  • Michel Kahaleh
Original Article

DOI: 10.1007/s10620-011-1743-6

Cite this article as:
Tekola, B., Wang, A.Y., Ramanath, M. et al. Dig Dis Sci (2011) 56: 3364. doi:10.1007/s10620-011-1743-6

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.

Keywords

Roux-en-Y gastric bypass Hepaticojejunostomy Pancreaticoduodenectomy ERCP 

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Bezawit Tekola
    • 1
  • Andrew Y. Wang
    • 1
  • Madhuri Ramanath
    • 1
  • Brent Burnette
    • 1
  • Kristi Ellen
    • 1
  • Bruce D. Schirmer
    • 2
  • Peter T. Hallowell
    • 2
  • Bryan G. Sauer
    • 1
  • Michel Kahaleh
    • 1
    • 3
  1. 1.Digestive Health Center of Excellence, Department of MedicineUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Department of SurgeryUniversity of Virginia Health SystemCharlottesvilleUSA
  3. 3.Division of Gastroenterology and HepatologyUniversity of Virginia Health SystemCharlottesvilleUSA

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