caa a22 4500 445797738 CHVBK 20180317145131.0 cr unu---uuuuu 170323e20111101xx s 000 0 eng 10.1007/s10620-011-1743-6 doi (NATIONALLICENCE)springer-10.1007/s10620-011-1743-6 Percutaneous Gastrostomy Tube Placement to Perform Transgastrostomy Endoscopic Retrograde Cholangiopancreaticography in Patients with Roux-en-Y Anatomy [Elektronische Daten] [Bezawit Tekola, Andrew Wang, Madhuri Ramanath, Brent Burnette, Kristi Ellen, Bruce Schirmer, Peter Hallowell, Bryan Sauer, Michel Kahaleh] 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 45days 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 52years, range 37-61years) 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 42days (range 7-123days). Conclusion: Surgical open gastrostomy followed by TG-ERCP enables therapeutic intervention but is associated with significant complications. Springer Science+Business Media, LLC, 2011 Roux-en-Y gastric bypass nationallicence Hepaticojejunostomy nationallicence Pancreaticoduodenectomy nationallicence ERCP nationallicence Tekola Bezawit Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut Wang Andrew Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut Ramanath Madhuri Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut Burnette Brent Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut Ellen Kristi Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut Schirmer Bruce Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA aut Hallowell Peter Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA aut Sauer Bryan Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut Kahaleh Michel Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/11(2011-11-01), 3364-3369 0163-2116 56:11<3364 2011 56 10620 https://doi.org/10.1007/s10620-011-1743-6 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-011-1743-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tekola Bezawit Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Wang Andrew Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Ramanath Madhuri Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Burnette Brent Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Ellen Kristi Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Schirmer Bruce Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Hallowell Peter Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Sauer Bryan Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut NATIONALLICENCE 700 1- Kahaleh Michel Digestive Health Center of Excellence, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/11(2011-11-01), 3364-3369 0163-2116 56:11<3364 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer