Subject(s)
Esophageal Stenosis/therapy , Stents/adverse effects , Vocal Cord Paralysis/etiology , Anastomosis, Surgical/adverse effects , Cutaneous Fistula/therapy , Device Removal , Esophageal Fistula/therapy , Esophageal Stenosis/etiology , Esophagus/surgery , Humans , Male , Middle Aged , Stomach/surgeryABSTRACT
BACKGROUND: Roux-en-Y reconstruction excludes the afferent limb and the biliopancreatic system from conventional endoscopic access. Postoperative problems in these excluded gastrointestinal systems are therefore often dealt with surgically. We investigated the usefulness of the therapeutic double-balloon enteroscope to perform interventional endoscopic procedures in the excluded segment of the gastrointestinal tract after Roux-en-Y reconstruction. METHODS: 30 procedures were performed in 22 patients with Roux-en-Y reconstruction after enterobiliary anastomosis, gastrectomy or bariatric gastric bypass. All procedures were performed with the therapeutic double-balloon enteroscope, under general anesthesia and with fluoroscopic control. RESULTS: ERCP at the enterobiliary anastomosis was successful in 90% (n = 10) of the procedures. ERCP at the intact papilla was successful in 60% (n = 5). Enterocutaneous fistula closure after (sub)total gastrectomy was performed in 2 procedures. Successful diagnostic procedures encompassed intubation of the excluded stomach after bariatric gastric bypass (89%, n = 9) or the afferent limb after Roux-en-Y reconstruction (75%, n = 4). The overall success rate in accessing the aimed excluded segment with the double-balloon enteroscope was 87%. Interventional procedures were able to avoid surgery in 65%. One retroperitoneal perforation occurred during ERCP which was conservatively treated. CONCLUSIONS: Excluded gastrointestinal segments after Roux-en-Y reconstruction can be accessed with a substantial success rate using double-balloon enteroscopy. Therapeutic interventions like ERCP can prevent surgery in the majority of patients.
Subject(s)
Anastomosis, Roux-en-Y/adverse effects , Catheterization , Endoscopes, Gastrointestinal , Endoscopy, Gastrointestinal , Intestine, Small/surgery , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic/diagnosis , Constriction, Pathologic/therapy , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
A patient with a history of a laparoscopic gastric bypass presented with a perforated duodenal ulcer. The ulcer was laparoscopically oversewn, and an omentoplasty was performed. Postoperatively, a broad spectrum antibiotic and a proton pump inhibitor were administrated. Several questions arise regarding the diagnosis and treatment of duodenal ulcers after gastric bypass. What are the diagnostic tools to detect a duodenal ulcer, and how should Helicobacter pylori be diagnosed after gastric bypass? The key question is whether the bypassed stomach should be resected as a definitive treatment for complicated duodenal ulcers.
