- Email: [email protected]
Transhepatic tract for visualization of the remnant stomach after Roux-en-Y gastric bypass
Accepted Manuscript Transhepatic tract for visualization of the remnant stomach after Roux-en-Y gastric bypass Chin Hong Lim, MD, David Hunter, MD, Daniel B. Leslie, MD, FACS, Sayeed Ikramuddin, MD, FACS PII:
S0016-5107(16)30140-7
DOI:
10.1016/j.gie.2016.05.007
Reference:
YMGE 10012
To appear in:
Gastrointestinal Endoscopy
Received Date: 10 March 2016 Accepted Date: 4 May 2016
Please cite this article as: Lim CH, Hunter D, Leslie DB, Ikramuddin S, Transhepatic tract for visualization of the remnant stomach after Roux-en-Y gastric bypass, Gastrointestinal Endoscopy (2016), doi: 10.1016/j.gie.2016.05.007. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Transhepatic tract for visualization of the remnant stomach after Roux-en-
RI PT
Y gastric bypass
Chin Hong Lim1, MD, David Hunter2, MD, Daniel B Leslie1, MD, FACS, Sayeed Ikramuddin1, MD, FACS
1
SC
Division of Minimally Invasive Gastrointestinal Surgery and Medicine, Department of Surgery, University of
Minnesota Medical Center, Minneapolis, MN 2
M AN U
Division of Interventional Radiology, Department of Radiology, University of Minnesota Medical Center,
Corresponding Author Chin Hong Lim
TE D
Minneapolis, Minneapolis, MN
EP
Department of Minimally Invasive Gastrointestinal Surgery University of Minnesota Medical Center
AC C
516 Delaware St SE
11-164 Phillips-Wangensteen Building Minneapolis, MN 55455 Phone: 612-979-8898 Fax: 612-625-3206 Email: [email protected]
ACCEPTED MANUSCRIPT
This patient had a history of multiple abdominal surgeries and recurrent ventral hernia (Fig 1A). Therefore, the usual methods of CT-guided or laparoscopic-assisted access to the gastric remnant was not possible without extensive adhesiolysis. We offered a novel technique to access and evaluate
RI PT
symptomatic iron deficiency anemia that was not responsive to oral replacement. The procedure was performed in 2 stages. The patient was positioned supine while under general anesthesia. US was used to evaluate segment V, but no bile ducts were visible. The 2 visible branches of the segment 5 portal
SC
vein were used as landmarks. After one puncture through the capsule with a 21-gauge Chiba needle (Cook Medical, Bloomington, Ind) and intrahepatic repositioning of the needle tip, a small bile duct was
M AN U
partially entered. Contrast was injected to opacify the ducts while a fluoroscopically guided puncture with a second 21-gauge needle was made into a more central portion (Fig 1B). A 0.018-inch nitinol wire (Cook Medical, Bloomington, Ind) was passed into the duodenum. A 6F triaxial introducer set (Vascular Solutions, Maple Grove, Minn) was placed over the small wire, and a second 0.035-inch
TE D
wire placed into the duodenum. The transhepatic tract was dilated to accommodate a 12F sheath (Fig 1C). A 10F, 60-cm pediatric bronchoscope (BF-XP190, Olympus, Center Valley, Pa) was able to loop back into the proximal duodenum, but was too short to reach the gastric remnant. In addition, it was noted
EP
that the transhepatic tract traversed a small hepatic vein branch. It was elected not to further dilate the tract, and a 14F internal-external drain was placed to allow the transhepatic tract to mature.
AC C
Two weeks later, under monitored anesthesia care, the biliary drainage catheter was replaced with a 14F sheath (Cook Medical, Bloomington, Ind). Catheters and wires were looped in the duodenum, and a stiff wire was curled in the gastric remnant. The Spyglass (10-French, 231-cm working length) (Boston Scientific, Marlborough, Mass) endoscope was placed through the sheath, looped in the duodenum, and advanced alongside the wire to visualize the gastric remnant (Fig.1D) (Video 1). At the completion of the procedure, a 14F internal-external biliary drain catheter was reinserted and removed 4 weeks later. Gastric biopsies of the remnant stomach showed reactive gastropathy.
ACCEPTED MANUSCRIPT
Legends
RI PT
Figure 1: A, CT scan showed a large ventral hernia containing the transverse colon with mesh from a previous repair. A cholangiogram demonstrated good antegrade flow of contrast through the biliary system into the duodenum (B), and a 12F sheath and guidewire within the gastric remnant (C) showed
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prior insertion of Spyglass (D).
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12 Fr Sheath
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Video 1: Transhepatic visualization of the remnant stomach with Spyglass after Roux-en-Y Gastric
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Spyglass
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S0016-5107(16)30140-7
DOI:
10.1016/j.gie.2016.05.007
Reference:
YMGE 10012
To appear in:
Gastrointestinal Endoscopy
Received Date: 10 March 2016 Accepted Date: 4 May 2016
Please cite this article as: Lim CH, Hunter D, Leslie DB, Ikramuddin S, Transhepatic tract for visualization of the remnant stomach after Roux-en-Y gastric bypass, Gastrointestinal Endoscopy (2016), doi: 10.1016/j.gie.2016.05.007. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Transhepatic tract for visualization of the remnant stomach after Roux-en-
RI PT
Y gastric bypass
Chin Hong Lim1, MD, David Hunter2, MD, Daniel B Leslie1, MD, FACS, Sayeed Ikramuddin1, MD, FACS
1
SC
Division of Minimally Invasive Gastrointestinal Surgery and Medicine, Department of Surgery, University of
Minnesota Medical Center, Minneapolis, MN 2
M AN U
Division of Interventional Radiology, Department of Radiology, University of Minnesota Medical Center,
Corresponding Author Chin Hong Lim
TE D
Minneapolis, Minneapolis, MN
EP
Department of Minimally Invasive Gastrointestinal Surgery University of Minnesota Medical Center
AC C
516 Delaware St SE
11-164 Phillips-Wangensteen Building Minneapolis, MN 55455 Phone: 612-979-8898 Fax: 612-625-3206 Email: [email protected]
ACCEPTED MANUSCRIPT
This patient had a history of multiple abdominal surgeries and recurrent ventral hernia (Fig 1A). Therefore, the usual methods of CT-guided or laparoscopic-assisted access to the gastric remnant was not possible without extensive adhesiolysis. We offered a novel technique to access and evaluate
RI PT
symptomatic iron deficiency anemia that was not responsive to oral replacement. The procedure was performed in 2 stages. The patient was positioned supine while under general anesthesia. US was used to evaluate segment V, but no bile ducts were visible. The 2 visible branches of the segment 5 portal
SC
vein were used as landmarks. After one puncture through the capsule with a 21-gauge Chiba needle (Cook Medical, Bloomington, Ind) and intrahepatic repositioning of the needle tip, a small bile duct was
M AN U
partially entered. Contrast was injected to opacify the ducts while a fluoroscopically guided puncture with a second 21-gauge needle was made into a more central portion (Fig 1B). A 0.018-inch nitinol wire (Cook Medical, Bloomington, Ind) was passed into the duodenum. A 6F triaxial introducer set (Vascular Solutions, Maple Grove, Minn) was placed over the small wire, and a second 0.035-inch
TE D
wire placed into the duodenum. The transhepatic tract was dilated to accommodate a 12F sheath (Fig 1C). A 10F, 60-cm pediatric bronchoscope (BF-XP190, Olympus, Center Valley, Pa) was able to loop back into the proximal duodenum, but was too short to reach the gastric remnant. In addition, it was noted
EP
that the transhepatic tract traversed a small hepatic vein branch. It was elected not to further dilate the tract, and a 14F internal-external drain was placed to allow the transhepatic tract to mature.
AC C
Two weeks later, under monitored anesthesia care, the biliary drainage catheter was replaced with a 14F sheath (Cook Medical, Bloomington, Ind). Catheters and wires were looped in the duodenum, and a stiff wire was curled in the gastric remnant. The Spyglass (10-French, 231-cm working length) (Boston Scientific, Marlborough, Mass) endoscope was placed through the sheath, looped in the duodenum, and advanced alongside the wire to visualize the gastric remnant (Fig.1D) (Video 1). At the completion of the procedure, a 14F internal-external biliary drain catheter was reinserted and removed 4 weeks later. Gastric biopsies of the remnant stomach showed reactive gastropathy.
ACCEPTED MANUSCRIPT
Legends
RI PT
Figure 1: A, CT scan showed a large ventral hernia containing the transverse colon with mesh from a previous repair. A cholangiogram demonstrated good antegrade flow of contrast through the biliary system into the duodenum (B), and a 12F sheath and guidewire within the gastric remnant (C) showed
SC
prior insertion of Spyglass (D).
bypass.
12 Fr Sheath
M AN U
Video 1: Transhepatic visualization of the remnant stomach with Spyglass after Roux-en-Y Gastric
AC C
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TE D
Spyglass
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