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. 2020 Jun 28;5(10):461-463.
doi: 10.1016/j.vgie.2020.05.026. eCollection 2020 Oct.

Every trick in the book: EUS angiotherapy for management of refractory bleeding secondary to a complicated duodenal ulcer in a patient with Roux-en-Y gastric bypass

Neil B Marya  1 , Tarek Sawas  1 , Vinay Chandrasekhara  1 , Veeravich Jaruvongvanich  1 , Daniel Maselli  1 , Michael J Levy  1 , Reem Matar  1 , Andrew C Storm  1 , Barham K Abu Dayyeh  1
Affiliations

Every trick in the book: EUS angiotherapy for management of refractory bleeding secondary to a complicated duodenal ulcer in a patient with Roux-en-Y gastric bypass

Neil B Marya et al. VideoGIE. .
No abstract available

Keywords: GDA, gastroduodenal; LAMS, lumen apposing metal stent; RYGB, Roux-en-Y gastric bypass.

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Figures

Figure 1
Figure 1
CT scan demonstrating the presence of a perforation at the duodenal apex (red circle) in a patient with Roux-en-Y gastric bypass anatomy.
Figure 2
Figure 2
Endoscopic image demonstrating the presence of a large blood clot emanating from the pancreaticobiliary limb in a patient with Roux-en-Y gastric bypass anatomy.
Figure 3
Figure 3
Fluoroscopic images of placement of a lumen-apposing metal stent from the blind limb of the gastrojejunostomy to the excluded stomach.
Figure 4
Figure 4
Endoscopic image of directed injection of dilute epinephrine into the base of an actively bleeding duodenal ulcer.
Figure 5
Figure 5
Fluoroscopic (A) and endoscopic (B) images of deployment of a fully covered metal stent in the excluded duodenum for an attempt at hemostasis.
Figure 6
Figure 6
Sonographic identification of a 1.8-mm arterial vessel at the base of an ulcer at the duodenal apex.
Figure 7
Figure 7
Fluoroscopic image of EUS-directed injection of microcoils into a branch of the gastroduodenal artery.
See this image and copyright information in PMC

References

    1. Kedia P., Sharaiha R.Z., Kumta N.A. Internal EUS-directed transgastric ERCP (EDGE): game over. Gastroenterology. 2014;147:566–568. - PubMed
    1. Kedia P., Kumta N.A., Widmer J. Endoscopic ultrasound-directed transgastric ERCP (EDGE) for Roux-en-Y anatomy: a novel technique. Endoscopy. 2015;47:159–163. - PubMed
    1. Krafft M.R., Hsueh W., James T.W. The EDGI new take on EDGE: EUS-directed transgastric intervention (EDGI), other than ERCP, for Roux-en-Y gastric bypass anatomy: a multicenter study. Endosc Int Open. 2019;7:E1231–E1240. - PMC - PubMed