Endosonography-guided transgastric ERCP in two patients with Roux-en-Y gastric bypass and successful closure of gastrogastrostomy using the Helix-Tack System

In patients with obesity following Roux-en-Y gastric bypass and choledocholithiasis, endosonography-guided transgastric ERCP (EDGE) has recently emerged as an alternative to conventional techniques such as enteroscopy-assisted ERCP, percutaneous transhepatic cholangiography (PTCD), or laparoscopic ERCP. This approach is feasible after creating a gastrogastrostomy with a lumen-apposing metal stent (LAMS). Both patients had previously undergone Roux-en-Y gastric bypass for weight reduction. They were admitted with abdominal pain, and diagnostic work-up including laboratory tests, abdominal ultrasound, and cross-sectional imaging confirmed choledocholithiasis. After thorough discussion of available options for stone extraction, including enteroscopy-assisted ERCP, PTCD, and laparoscopic ERCP, both patients opted for EDGE.Endosonography-guided puncture of the excluded stomach was performed, followed by placement of a LAMS. After balloon dilation of the LAMS, ERCP was carried out, and the stones were successfully removed using a duodenoscope. Four to six weeks later, the LAMS was removed, and the gastrogastrostomy was closed using the Helix-Tack suturing system. Follow-up gastroscopy showed successful and complication-free closure of the gastrogastrostomy.These two cases illustrate the feasibility of a minimally invasive, endoscopic approach to treat biliary complications in patients after Roux-en-Y gastric bypass. The Helix-Tack system provides a reliable method for closing gastrogastrostomies after LAMS removal

Publication History

Article published online:
27 March 2025