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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a24993468
DOI: 10.1055/a-2499-3468
Original article

Radiographic, fluoroscopic, and endosonographic predictors of failed EUS-guided transgastric stent placement in patients with Roux-en-Y bypass anatomy

Benjamin M Moy
1   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
,
Hero Hussain
2   Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
,
Jessica X Yu 
1   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
,
Kevin D Platt
1   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
,
Jorge D Machicado
1   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
,
Richard S Kwon
1   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
,
Erik-Jan Wamsteker
1   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
,
George M Philips
1   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
,
Allison R Schulman
1   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
3   Department of Surgery, University of Michigan, Ann Arbor, Michigan, United States (Ringgold ID: RIN1259)
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Abstract

Background and study aims

Gastric access temporary for endoscopy (GATE) via endoscopic ultrasound-guided stent placement between the gastric pouch/jejunum and remnant stomach is used in Roux-en-Y gastric bypass (RYGB) to facilitate endoscopic retrograde cholangiopancreatography or other maneuvers. This study aimed to identify radiographic predictors of GATE failure and intraprocedure reasons for aborting.

Patients and methods

Patients undergoing GATE were matched 3:1 on procedure success. Features indicating quality of the transgastric window were collected including: 1) gastric pouch/blind limb length; 2) location of remnant stomach relative to pouch or blind/roux limb; 3) pouch orientation; 4) remnant orientation; 5) length of contact; 6) tissue thickness; and 7) presence of poor contact (calcification, surgical material, intervening vasculature). Primary outcome was radiographic criteria associated with GATE failure. Secondary outcomes were endoscopic, endosonographic, and fluoroscopic intraprocedure reasons for aborting GATE.

Results

Forty patients (30 successful, 10 aborted, 82.5% female) who underwent GATE were included. Mean (±SD) age and time since RYGB were 62.8±11.9 and 15.1±8.6 years, respectively. There were no group demographic differences. The cumulative number of contact-related risk factors was associated with GATE failure (OR 26.1, 95% CI 0.004–0.337; P=0.004). Two or more factors increased the likelihood of GATE failure (P <0.05). Echoendoscope angulation/tip deflection, intervening vasculature, distance to remnant stomach, rapid emptying and/or insufficient filling of contrast were reported in cases of GATE failure.

Conclusions

Radiographic features may predict GATE failure including intervening vasculature or insufficient contact between gastric pouch/blind limb and remnant. Patients demonstrating these features may benefit from alternative treatment approaches early in management.

Keywords

Endoscopic ultrasonography - Intervention EUS - Pancreatobiliary (ERCP/PTCD) - Biliary tract


Publication History

Received: 19 August 2024

Accepted after revision: 05 December 2024

Accepted Manuscript online:
09 December 2024

Article published online:
29 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
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Bibliographical Record
Benjamin M Moy, Hero Hussain, Jessica X Yu, Kevin D Platt, Jorge D Machicado, Richard S Kwon, Erik-Jan Wamsteker, George M Philips, Allison R Schulman. Radiographic, fluoroscopic, and endosonographic predictors of failed EUS-guided transgastric stent placement in patients with Roux-en-Y bypass anatomy. Endosc Int Open 2025; 13: a24993468.
DOI: 10.1055/a-2499-3468
 

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