Endoscopic Exploration of the Excluded Stomach in Roux-en-Y Gastric Bypass Patients: Which Enteroscope to Use?

Roux-en-Y gastric bypass (RYGB) is an effective surgical intervention to treat obesity. However, the reconstruction precludes the biliopancreatic limb and the excluded stomach from conventional endoscopic access. Unfortunately, life-threatening pathology may occur in these excluded segments. [...

Futures perspectives and therapeutic applications.

INTRODUCTION : The evolution of endoscopic ultrasound (EUS) has been recently more and more exponential, allowing a paradigm shift from diagnosis to therapy. Initially, EUS was developed to improve characterization of lesions an/or organs behind the digestive wall. Then, Availability of large working channel allowed to perform needle punctures through the digestive wall of the lesions observed. [...

Endoscopic Vacuum Therapy of Upper Gastrointestinal Anastomotic Leaks: How to Deal with the Challenges (with Video)

Anastomotic leaks after gastrointestinal surgery have an important impact on surgical outcomes because of the high morbidity and mortality rates. Multiple treatment options exist requiring an individualized patient-tailored treatment plan after multidisciplinary discussion. Endoscopic vacuum therapy (EVT) is a novel treatment option that is nowadays recognized as an effective and useful endoscopic approach to treat leaks or perforations in both the upper and lower gastrointestinal tract. EVT has a very good safety profile. However, it is a time-consuming endeavour requiring engagement from the endoscopist and understanding from the patient. To the unexperienced, the EVT technique may be prone to several hurdles which may deter endoscopists from using it and depriving patients from a potentially life-saving therapeutic option. The current review highlights the possible difficulties of the EVT procedure and aims to provide some practical solutions to facilitate its use in daily clinical practice. Personal tips and tricks are shared to overcome the pre-, intra- and post-procedural hurdles. An instructive video of the procedure helps to illustrate the technique of EVT

Endoscopic ultrasound-guided management of malignant afferent loop syndrome after gastric bypass: from diagnosis to therapy.

Afferent loop syndrome (ALS) is a known complication of surgical gastrectomy [1], caused by benign or malignant obstruction of the afferent limb, which induces digestive intolerance and reflux cholangitis. With the explosion of bariatric surgery, a new patient population with altered anatomy has emerged [2], presenting new endoscopic challenges. Therapeutic possibilities using endoscopic ultrasound (EUS) are constantly increasing thanks to new devices [3] [4]. We present an original case of a patient with ALS due to pancreatic adenocarcinoma that occurred years after a gastric bypass.[...

How to endoscopically repair a biliodigestive fistula complicating a perforated peptic ulcer: a customized "natural" choledochoduodenal anastomosis.

A perforated peptic ulcer is associated with a 30 % mortality and 50 % morbidity and is usually managed as a surgical emergency [1]. To seal the perforation, applying interrupted sutures with omental apposition is the most commonly used technique [2]. In a few cases, a perforated peptic ulcer may be complicated by a choledochoduodenal fistula, which is managed surgically by laparoscopic digestive resection [3] or medically with a protein pump inhibitor and endoscopic retrograde cholangiopancreatography (ERCP). We present a case of a biliary fistula complicating a perforated peptic ulcer that was managed endoscopically in an original way. [...

Motorized spiral enteroscopy: effectiveness when used for new indications.

BACKGROUND AND STUDY AIMS: Motorized spiral enteroscopy is proven to be effective in antegrade and retrograde enteroscopy. Nevertheless, little is known about its use in less common indications. The aim of this study was to identify new indications for the motorized spiral enteroscope. METHODS: Monocentric retrospective analysis of 115 patients who underwent enteroscopy using PSF-1 motorized spiral enteroscope between January 2020 and December 2022. RESULTS: A total of 115 patients underwent PSF-1 enteroscopy. 44 (38%) were antegrade procedures and 24 (21%) were retrograde procedures in patients with normal gastrointestinal anatomy with conventional enteroscopy indications. The remaining 47 (41%) patients underwent PSF-1 procedures for secondary less conventional indications: n=25 (22%) enteroscopy-assisted ERCP, n=8 (7%) endoscopy of the excluded stomach after Roux-en-Y gastric bypass, n=7 (6%) retrograde enteroscopy after previous incomplete conventional colonoscopy and n=7 (6%) antegrade panenteroscopy of the entire small bowel. In this group of secondary indications, technical success rate was significantly lower (72.5%) as compared to technical success rates in the conventional groups (98-100%, p<0.001 Chi-square). Minor adverse events occurred in 17/115 patients (15%), all treated conservatively (AGREE I and II). CONCLUSION: This study demonstrates the capabilities of PSF-1 motorized spiral enteroscope for secondary indications. PSF-1 is useful to complete colonoscopy in case of long redundant colon, to reach the excluded stomach after Roux-en-Y gastric bypass, to perform unidirectional pan-enteroscopy and to perform ERCP in patients with surgically altered anatomy. However, technical success rates are lower as compared to conventional antegrade and retrograde enteroscopy procedures, with only minor adverse events

Freehand endoscopic ultrasound-guided transrectal drainage of diverticulitis-associated abscess with electrocautery-enhanced lumen-apposing metal stent under spinal anesthesia.

Complicated diverticulitis occurs in 12 % of all diverticulitis cases. Radiological drainage is the first-line therapy in cases of large diverticulitis-associated abscess. However, the pelvic location renders the radiological access challenging. Lower endoscopic ultrasound (EUS)-guided drainage, using an electrocautery-enhanced lumen-apposing metal stent (LAMS), is a feasible and safe alternative method for drainage of pelvic collections. We present a case of a diverticulitis-associated abscess successfully treated using EUS-guided LAMS. [...

Percutaneous cholangioscopy with short Spyscope combined with endoscopic retrograde cholangiography in case of difficult intrahepatic bile duct stone.

No abstract availabl

Percutaneous cholangioscopy with short Spyscope combined with endoscopic retrograde cholangiography in case of difficult intrahepatic bile duct stone

No abstract availabl