Case Series: Endoscopic ultrasound-directed transgastric ERCP in liver transplant recipients with Roux-en-Y gastric bypass

Introduction: Among liver transplant recipients, Roux-en-Y gastric bypass (RYGB) may lead to postoperative malnutrition and nutrient deficiencies. Procedures such as the endoscopic ultrasound-directed transgastric ERCP (EDGE) can result in advantageous weight gain for liver transplant recipients with prior RYGB who do not respond to enteral or parenteral nutritional interventions. Methods: We present three patients who underwent EDGE for post-transplant malnutrition and weight loss. Results: EDGE resulted in weight gain across all patients. Liver transplant recipients with a history of RYGB may be at significant nutritional risk following transplant due to fat malabsorption, underestimation of resting energy expenditure, and appetite suppression mediated by neurohormonal signals. Conclusion: When traditional nutritional interventions are unsuccessful, the EDGE procedure may be an effective alternative to promote post-transplant weight gain in this unique population.