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Editorial
, 8 (3), 139-145

EUS-directed Transgastric Access to the Excluded Stomach to Facilitate Pancreaticobiliary Interventions in Patients With Roux-en-Y Gastric Bypass Anatomy

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Editorial

EUS-directed Transgastric Access to the Excluded Stomach to Facilitate Pancreaticobiliary Interventions in Patients With Roux-en-Y Gastric Bypass Anatomy

Robert A Moran et al. Endosc Ultrasound.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Timing of intervention for endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography
Figure 2
Figure 2
(a) EUS of the excluded stomach, note the thickened hypoechoic muscularis propria and the gastric rugae. (b) EUS of a jejunal loop, note the thin-walled muscularis propria and the absence of any rugae
Figure 3
Figure 3
Contrast filling the excluded stomach by way of EUS with transgastric puncture through the gastric antrum (a) and body (b). Note the gastric rugae and the typical shape of the excluded stomach on fluoroscopy
Figure 4
Figure 4
The stomach gradually distends (a-c) with sterile water and contrast through EUS with transgastric puncture. The distended stomach seen on image C easily facilitates transgastric placement of a lumen-apposing metal stent
Figure 5
Figure 5
Images A through D demonstrate endoscopic suturing of lumen-apposing metal stent. After the lumen-apposing metal stent has been dilated with a dilation balloon, it is secured with endoscopic sutures placed in close approximation to the flanges of the stent
Figure 6
Figure 6
Images A and B demonstrate an endoscopic retrograde cholangiopancreatography performed through the transgastric fistula, note the straight position of the duodenoscope without looping in the stomach
Figure 7
Figure 7
As we progress from image A through D the duodenoscope is advanced through the lumen-apposing metal stent with the aid of fluoroscopy
Figure 8
Figure 8
Transgastric fistula after removal of lumen-apposing metal stent (a and b). Argon plasma coagulation (40 watts, 2 L flow) applied aggressively to the transgastric fistula tract (c and d)

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