Gastric partitioning procedures utilized in bariatric surgery, which completely segment or transect the stomach, have the disadvantage of preventing direct access to the excluded stomach for evaluation of possible pathologic changes or the management of such diseases as peptic ulcer. Retrograde endoscopy is not possible where the combined length of the efferent jejunal limb and proximal jejunum exceeds that of the excluded stomach, and their adaptation to allow direct percutaneous endoscopy are described.

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A needle guide was used to create a fistula from an obstructed common bile duct to the duodenum in a patient with a large tumor of the head of the pancreas. The tortuosity and severity of the stricture prevented the use of routine guide wire passage. A 5-F hyperalimentation catheter was also placed, in addition to the biliary drainage stent.

No abstract