ASGE DDW Videos from Around the World | 2026-ENDOSCOPIC ULTRASOUND-DIRECTED TRANS-GASTRIC PERORAL ENDOSCOPIC PYLOROMYOTOMY IN A PATIENT WITH ROUX-EN-Y GASTRIC BYPASS

ENDOSCOPIC ULTRASOUND-DIRECTED TRANS-GASTRIC PERORAL ENDOSCOPIC PYLOROMYOTOMY IN A PATIENT WITH ROUX-EN-Y GASTRIC BYPASS

Back to course

Video Transcription

Video Summary

A 50-year-old woman developed suspected postsurgical gastroparesis and gastric outlet obstruction after multiple foregut surgeries, including Roux-en-Y gastric bypass. CT showed a distended gastric remnant and thickened pylorus. Because of her altered anatomy, endoscopic ultrasound-guided transgastric access was created with a lumen-apposing metal stent. Initial pyloric balloon dilation helped briefly, but symptoms recurred. She then underwent saline-immersion gastric peroral endoscopic pyloromyotomy, with successful tunneling, pyloromyotomy, and clip closure. Imaging showed free flow without leak. The LAMS was removed four weeks later, and she remained asymptomatic at four-month follow-up.

Asset Subtitle

Submitted by Dennis Yang

Keywords

postsurgical gastroparesis

gastric outlet obstruction

Roux-en-Y gastric bypass

endoscopic ultrasound-guided transgastric access

gastric peroral endoscopic pyloromyotomy