Post written by Christina S. Gainey, MD, from the Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

We present a novel method for placing a PEG tube into the excluded stomach of Roux-en-Y gastric bypass patients, allowing for bolus gastric feeding.

Although percutaneous endoscopic jejunostomy tubes are standard for long-term enteral feeding in Roux-en-Y gastric bypass patients, the jejunum’s limited capacity necessitates slow, prolonged feeds, negatively impacting quality of life. Our novel method offers the advantage of convenient bolus gastric feeding for these patients.

The risk of lumen-apposing stent dislodgment is very low during this procedure because it does not require the instrumentation and tension required during other procedures, such as an ERCP. Therefore, PEG tube placement can be performed in the same session as the EUS-guided gastrogastrostomy. The snare from the PEG kit can be used to collapse the internal bumper to facilitate passage through the lumen-apposing stent.

A PEG tube (EndoVive; Boston Scientific) was placed using the standard pull technique, with the exception of collapsing the internal bumper with the snare from the PEG kit (A) and passing the endoscope to deliver it into the excluded stomach avoiding lumen-apposing stent dislodgement (B).

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