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Abstract
Background and AimsIn patients with Roux-en-Y gastric bypass (RYGB) anatomy who require long-term enteral feeding, a percutaneous endoscopic jejunostomy (PEJ) tube is usually placed. However, jejunal feeding requires slower, continuous feeds compared with the physiologic bolus feeding with gastric feeds. This case series details a novel approach we term endoscopic ultrasound-directed transgastric percutaneous endoscopic gastrostomy (EDG-PEG) whereby endoscopic ultrasound (EUS)-guided gastrogastrostomy is performed using a lumen-apposing stent (LAMS) followed by a traditional percutaneous gastrostomy placement (PEG) via the newly created connection to allow for bolus gastric feeds in patients with Roux-en-Y anatomy. MethodsWe describe 3 cases in which an endoscopic ultrasound EUS-guided gastrogastrostomy was performed using a LAMS followed by the usual placement of a PEG tube into the excluded stomach. ResultsProcedure was technically and clinically successful in all 3 cases. ConclusionsEDG-PEG is an option for long-term enteral feeding in patients with a history of RYGB to allow for more convenient bolus gastric feeding rather than longer, continuous feeds required with a jejunal feeding tube.
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