Post written by Kambiz S. Kadkhodayan, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA. We describe 2 patients with Roux-en-Y gastric bypass (RYGB) who underwent double-balloon enteroscopy—assisted ERCP (DBE-ERCP) for the management of pancreatolithiasis and choledocholithiasis. After reaching the ampulla, deep cannulation of the bile duct could not be achieved using the enteroscope. …
Tag: Roux-en-Y
Endoscopic rescue of anastomotic dehiscence after urgent gastric bypass revision
Post written by Steven R. Siegal, MD, from AdventHealth, Orlando, Florida, USA. We demonstrate a case of a Roux-en-Y anastomotic dehiscence that was rescued via total endoscopic means over various sessions. It is important to know the available endoscopic tools and how they can be used in a complementary fashion to essentially perform surgical procedures. It …
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EUS-guided gastrojejunostomy for management of malignant gastric outlet obstruction in a patient with Roux-en-Y anatomy
Post written by Rishi Pawa, MD, FACG, from the Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. A 56-year-old man with a medical history of metastatic duodenal adenocarcinoma, status postpartial gastrectomy, and duodenectomy with Roux-en-Y gastrojejunostomy (GJ) presented with gastric outlet obstruction. Endoscopy revealed an ulcerated stricture at the gastrojejunal anastomosis, with biopsies confirming recurrent …
Bleeding at Roux-en-Y jejunojejunal anastomosis after orthotopic liver transplantation
Post written by Chaitanya Allamneni, MD, from the Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. A young woman with a medical history of primary sclerosing cholangitis/autoimmune hepatitis overlap syndrome diagnosed at age 2, complicated by decompensated cirrhosis, underwent orthotopic liver transplantation (OLT). During OLT she underwent a standard Roux-en-Y hepaticojejunostomy. Twenty-four …
“Two-devices-in-one-channel method” in a Roux-en-Y patient
Post written by Yohei Koyama, MD, from the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) has improved the outcomes of ERCP in patients with surgically altered anatomy. However, BE-ERCP requires high technical expertise, and biliary cannulation is often difficult. An 83-year-old man previously underwent total gastrectomy …
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Bypassing the bypass
Nikhil A. Kumta, MD from the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York, New York, USA presents this video case, "Bypassing the bypass: EUS-directed transgastric ERCP for Roux-en-Y anatomy." Patients with altered anatomy from a Roux-en-Y gastric bypass pose distinct challenges to performing endoscopic retrograde cholangiopancreatography (ERCP). In this …
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