Abstract
EUS directed trans-Gastric ERCP (EDGE) allows access to the excluded stomach in Roux-en-Y gastric bypass (RYGB) patients by means of gastro-gastrostomy or jejuno-gastrostomy. We similarly fashioned a jejuno-jejunal EUS-guided lumen-apposing metal stent (LAMS) anastomosis to allow through-the-stent (TTS) ERCP in a patient with recurrent pancreatitis and duodenal switch (DS), a type of bariatrically altered anatomy distinctly precluding peroral ERCP. Endoscopic techniques for localizing the biliary limb in DS and for salvaging LAMS dislodgment are presented.
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