PMC6317832_01
Computed tomography of abdomen showing the excluded stomach (arrow) with adjacent inflammation and mesenteric fat stranding.
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F1
Cross-sectional imaging after intravenous contrast administration showed a 7 x 7 cm collection in the left upper quadrant, likely representing a dilated gastric remnant, with adjacent mesenteric fat stranding and edema (Figure 1).
EUS-Guided access from the gastric pouch into the excluded stomach with a 19-gauge EchoTip needle.
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F2
This was accessed with a 19-gauge EchoTip needle (Cook Medical, Bloomington, IN) through the gastric pouch (Figure 2) with special attention to ensure that the puncture site was distal to the gastroesophageal junction.
Fluoroscopic image after deployment of a 10-mm by 4-cm covered Viabil metal stent into the excluded stomach.
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F3
An 0.035-in Jagwire (Boston Scientific, Marlborough, MA) was then coiled within the excluded stomach (Figure 3).
Computed tomography of the abdomen showing the gastrogastric conduit via a metal stent (arrow) and a decompressed gastric remnant.
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F4
After dilation of the tract with a Fusion 5-7-10 French push catheter (Cook Medical) and a 6-mm Hurricane RX balloon dilator (Boston Scientific), a gastrogastric conduit was created via deployment of a 10-mm by 4-cm fully-covered Viabil metal stent (Gore Medical, Flagstaff, AZ) under fluoroscopic and endoscopic guidance (Figure 4). The covered metal stent remains in place (Figure 4).