Presentation Title

Endoscopic Approach to Gastric Remnant Outlet Obstruction After Gastric Bypass

Speaker Credentials

DO

College

Dr. Kiran C. Patel College of Osteopathic Medicine, DO

Format

Poster

Start Date

6-11-2020 10:00 AM

End Date

6-11-2020 10:15 AM

Abstract

Introduction: Complications following Roux-en-Y gastric bypass (RYGB) can be acute or chronic and can be potentially life-threatening if not immediately recognized and treated. Acute gastric remnant bleeding is an infrequent complication of bariatric surgery. Endoscopic management is technically difficult, so surgery is the standard of care. We present a patient who had a timely diagnosis and successful treatment with endoscopic decompression using a lumen-apposing metal stent (LAMS). Case Presentation: A 65-year-old caucasian male presented with the sudden onset of progressive abdominal distention, and dry-heaves 10 years after gastric bypass. He was afebrile and hemodynamically stable. He appeared pale with conjunctival pallor. The abdomen was distended but non-tender with normal bowel sounds. The rectal exam exhibited melena. The CT-scan showed distention of the remnant stomach with heterogeneous fluid. Endoscopic decompression was achieved. He had a blood clot obstructing the remnant stomach. Biopsies were positive for Helicobacter pylori infection, which was treated. Deviation From the Expected: One would not expect such a sudden presentation of gastric outlet obstruction in a patient such as this. Discussion: This patient was treated via endoscopically with placement of a LAMS via endoscopic ultrasound guidance. This technique has a better safety profile than the standard of care, which, at this time, is surgery. Conclusion: You should consider remnant gastric outlet obstruction in a gastric bypass patient who has abdominal distention without emesis. You should consult the Gastroenterology service because an endoscopic approach can be considered. Grants: No grants or funding

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Nov 6th, 10:00 AM Nov 6th, 10:15 AM

Endoscopic Approach to Gastric Remnant Outlet Obstruction After Gastric Bypass

Introduction: Complications following Roux-en-Y gastric bypass (RYGB) can be acute or chronic and can be potentially life-threatening if not immediately recognized and treated. Acute gastric remnant bleeding is an infrequent complication of bariatric surgery. Endoscopic management is technically difficult, so surgery is the standard of care. We present a patient who had a timely diagnosis and successful treatment with endoscopic decompression using a lumen-apposing metal stent (LAMS). Case Presentation: A 65-year-old caucasian male presented with the sudden onset of progressive abdominal distention, and dry-heaves 10 years after gastric bypass. He was afebrile and hemodynamically stable. He appeared pale with conjunctival pallor. The abdomen was distended but non-tender with normal bowel sounds. The rectal exam exhibited melena. The CT-scan showed distention of the remnant stomach with heterogeneous fluid. Endoscopic decompression was achieved. He had a blood clot obstructing the remnant stomach. Biopsies were positive for Helicobacter pylori infection, which was treated. Deviation From the Expected: One would not expect such a sudden presentation of gastric outlet obstruction in a patient such as this. Discussion: This patient was treated via endoscopically with placement of a LAMS via endoscopic ultrasound guidance. This technique has a better safety profile than the standard of care, which, at this time, is surgery. Conclusion: You should consider remnant gastric outlet obstruction in a gastric bypass patient who has abdominal distention without emesis. You should consult the Gastroenterology service because an endoscopic approach can be considered. Grants: No grants or funding