Single-Session Endoscopic Ultrasound-Directed Transgastric Intervention for a Fine Needle Biopsy of Pancreatic Head Mass Using Endoscopic Through-the-Scope Suturing in a Patient With Roux-en-Y Gastric Bypass Anatomy

Raghav Bassi; Francis I Macedo; Yaseen Perbtani; Tony S Brar

doi:10.14309/crj.0000000000001290

Single-Session Endoscopic Ultrasound-Directed Transgastric Intervention for a Fine Needle Biopsy of Pancreatic Head Mass Using Endoscopic Through-the-Scope Suturing in a Patient With Roux-en-Y Gastric Bypass Anatomy

ACG Case Rep J. 2024 Feb 28;11(3):e01290. doi: 10.14309/crj.0000000000001290. eCollection 2024 Mar.

Authors

Raghav Bassi¹, Francis I Macedo², Yaseen Perbtani^{1

3}, Tony S Brar^{1

3}

Affiliations

¹ University of Central Florida College of Medicine, Graduate Medical Education/HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL.
² Division of Surgical Oncology, Department of Surgery, HCA Florida North Florida Hospital, Gainesville, FL.
³ Division of Gastroenterology, Department of Internal Medicine, HCA Florida North Florida Hospital, Gainesville, FL.

Abstract

Endoscopic ultrasound (EUS) is a diagnostic tool used to examine pancreatic lesions. In patients who have undergone Roux-en-Y gastric bypass, lesions of the pancreatic head can be difficult to access because of altered foregut anatomy. To access the excluded stomach for better visualization of the pancreatic head, EUS-directed transgastric intervention can be used in a 2-step fashion. We present an interesting case of a 62-year-old woman who underwent a single-session modified EUS-directed transgastric intervention with a fine needle biopsy of a pancreatic head mass. A novel through-the-scope suturing system, the X-tack system (Apollo Endosurgery, Austin, TX), was used to allow for a successful single-session procedure.

Keywords: EUS-directed transgastric intervention; X-tack suturing system; fine-needle biopsy; pancreatic cancer.

Publication types

Case Reports