Percutaneous Gastrostomy Placement for Decompression of the Excluded Gastric Remnant following Roux-en-Y Gastric Bypass Surgery

Abstract

Purpose To evaluate the feasibility and safety of percutaneous gastrostomy for decompression of the excluded stomach in patients’ status post Roux-en-Y gastric bypass (RYGB).

Materials and Methods Between January 2001 and August 2017, 10 consecutive RYGB patients who underwent placement of a decompressive gastrostomy of the excluded stomach were identified in an institutional database. Technical success was defined as successful gastrostomy catheter placement in the bypassed stomach using fluoroscopy and/or ultrasound guidance. Clinical success was established if dilation of the excluded stomach improved after gastrostomy with resolution of associated symptoms. Charts were reviewed for treatment-related adverse events post-procedure.

Results The cohort was predominantly female (9/10), with an average age of 54 ± 14 years. Median follow-up was 35.2 months (range: 0.6–115). Indications for decompressive gastrostomy placement included small bowel obstruction (6/10) or afferent limb obstruction at the jejunojejunal anastomosis (4/10). The most common presenting symptoms were abdominal pain, distension, and vomiting. All patients had successful gastrostomy placement in the excluded remnant, using ultrasound and fluoroscopic guidance, with no procedural complications. The 12 to 16F Cope loop catheters was used in this cohort, and gastropexy sutures were used in two cases. All 10 patients demonstrated clinical resolution of symptoms after gastrostomy placement. Two patients developed minor complications of tube site leakage and poor tube function requiring gastrostomy exchange within 1 week of the procedure.

Conclusion Fluoroscopic and ultrasound-guided percutaneous gastrostomy catheter placement is a safe, effective, and feasible approach to treating dilation of the excluded gastric remnant in RYGB patients.

Keywords

Roux-en-Y - percutaneous decompression - gastrostomy

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