Single-session EUS-Directed trans-Gastric Intervention (EDGI) through a lumen apposing metal stent (LAMS) for polypectomy in the excluded stomach in Roux-en-Y gastric bypass (RYGB)

Abstract Text CT revealed a large pre-pyloric polyp in a 56-year-old male with RYGB. The excluded stomach was identified with a linear echoendoscope and EUS-punctured with a 19-G needle followed by saline injection for distension. A 20x10 LAMS was deployed across the gastric wall, followed by 18-mm balloon dilation. Through-the-LAMS gastroscopy revealed a 30-mm polyp (Paris 0-Isp). Piece-meal endoscopic resection was performed using a double channel gastroscope. The large mucosal defect was closed using two Over-The-Scope-Clips. Pathology revealed a Brunner gland tumor. Single-session EDGI conveniently allows therapy in the excluded stomach.