Investigation of the excluded stomach after Roux-en-Y gastric bypass: The role of percutaneous endoscopy

Abstract

Accessing the bypassed portion of the stomach via conventional endoscopy is difficult following Roux-en-Y gastric bypass surgery. However, endoscopic examination of the stomach and small bowel is possible through percutaneous access into the bypassed stomach (BS) with a combined radiologic and endoscopic technique. We present a case of obscure overt gastrointestinal (GI) bleeding where the source of bleeding was thought to be from the BS. After conventional endoscopic methods failed to examine the BS, percutaneous endoscopy (PE) was used as an alternative to surgical exploration.

A Novel Endoscopic Technique to Diagnose Gastric Cancer in Excluded Stomach after Roux-en-Y Gastric Bypass

“…Although it is effective in reducing mortality and morbidity related to morbid obesity, it creates a challenge for gastroenterologists in terms of endoscopic evaluation of the excluded duodenum, proximal jejunum, biliary tree, and stomach. Several techniques have been described to access the bypassed portion of the stomach, including surgical exploration, retrograde endoscopy, percutaneous endoscopy by way of gastrostomy with a combined radiologic and endoscopic technique, and DBE 4-9…”

“…Several techniques have been described to access the bypassed portion of the stomach, including surgical exploration, retrograde endoscopy, percutaneous endoscopy by way of gastrostomy with a combined radiologic and endoscopic technique, and DBE. 4 - 9 …”