Double-balloon enteroscopy for luminal evaluation of the excluded stomach: a retrospective multicenter analysis

Background and Aims: After Roux-en-Y gastric bypass (RYGB), accessing the excluded or remnant stomach (RS) is difficult using standard endoscopy, and double-balloon enteroscopy (DBE) is often used when pathology is suspected. Data on the use of DBE for this purpose are limited. We investigated the success rate, technical factors, and findings when using DBE to access the RS after RYGB. Methods: This was a retrospective analysis of adult patients with RYGB who underwent DBE to access the RS between January 2018 and July 2023 across 3 academic medical centers. Primary aims were identifying the technical success rate of accessing the RS and associated endoscopic findings. Secondary aims were identifying patient characteristics, procedure indications, factors behind technical failures, studies preceding DBE, endoscopic therapies performed, and procedural adverse events. Results: Eighty-nine patients underwent DBE to access the RS after RYGB for anemia/bleeding (56.2%), abdominal pain (32.6%), and abnormal imaging (44.9%). The RS was successfully accessed in 71.9% of cases. The most common reasons the RS was not accessed were proximal pathology (40%), anastomotic angulation (32%), and limb length (16%). Many (40.4%) examination results were normal. The most common findings were inflammatory (30.3%) or vascular (15.7%), 6.7% had polyps, and 5.6% had malignant neoplasm. Biopsy (50.6%) and hemostatic maneuvers (20.2%) were commonly performed. Accessing the RS was not associated with patient age, procedural indication, or time from RYGB. DBE served as definitive management in 29.2% of cases, and no procedural adverse events occurred. Conclusions: The RS in RYGB can be successfully and safely accessed with DBE.