Complex dysfunction of gastric bypass bariatric surgery due to complications from a second surgery: endoscopic approach

A 49-year-old woman, with the history of a gastric bypass, is diagnosed with cholangiocarcinoma 16 years later, and underwent left hepatic trisegmentectomy. Postoperative course complicated by a biliary leak, and the formation of a collection of dense tissue in the surgical bed. The efferent loop of the bypass became trapped within this tissue conditioning food intolerance and severe malnutrition. Through endoscopic ultrasound (EUS), a gastrogastric anastomosis was created between the gastric pouch and the excluded stomach using a luminal apposition stent. Due to duodenal obstruction, also trapped in the described tissue, a gastroenterostomy was performed between the excluded stomach and the jejunum using a second stent.The patient subsequently showed good clinical progress, with adequate oral intake and recovery of nutritional status.

Publication History

Article published online:
27 March 2025