Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2017; 9(10): 521-528
Published online Oct 16, 2017. doi: 10.4253/wjge.v9.i10.521
Two case reports of acute upper gastrointestinal bleeding from duodenal ulcers after Roux-en-Y gastric bypass surgery: Endoscopic diagnosis and therapy by single balloon or push enteroscopy after missed diagnosis by standard esophagogastroduodenoscopy
Seifeldin Hakim, Srinivas R Rami Reddy, Mihaela Batke, Gregg Polidori, Mitchell S Cappell
Seifeldin Hakim, Srinivas R Rami Reddy, Mihaela Batke, Gregg Polidori, Mitchell S Cappell, Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, MI 48073, United States
Mitchell S Cappell, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, United States
Author contributions: Hakim S and Cappell MS are equal primary authors; Hakim S helped in reviewing and editing the two case reports, and wrote a preliminary version of the Introduction, and Discussion sections; Cappell MS was the mentor for Hakim S and Reddy SRR for this paper; Cappell MS supervised the writing of the entire paper, including writing parts of the Introduction and Discussion sections, and thoroughly edited the entire paper; Batke M was the attending clinician treating patient 1, wrote up a preliminary version of this case report, and reviewed the rest of the paper; Polidori G was the attending treating patient 2, wrote up a preliminary version of this case report, and reviewed the rest of the paper; Reddy SRR was the GI fellow treating patients 1 and 2, and assisted in the writing of the 2 case reports.
Institutional review board statement: William Beaumont Hospital IRB approved/exempted study on 12/16/16.
Informed consent statement: Exempted.
Conflict-of-interest statement: None. In particular, Dr. Cappell, as a consultant of the United States Food and Drug Administration (FDA) Advisory Committee for Gastrointestinal Drugs, affirms that this paper does not discuss any proprietary, confidential, pharmaceutical data submitted to the FDA; Dr. Cappell is also a member of the speaker’s bureau for AstraZeneca and Daiichi Sankyo, co-marketers of Movantik. This work does not discuss any drug manufactured or marketed by AstraZeneca or Daiichi Sankyo.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mitchell S Cappell, MD, PhD, Director, Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, MOB# 602, 3535 West Thirteen Mile Road, Royal Oak, MI 48073, United States. mitchell.cappell@beaumont.edu
Telephone: +1-248-5511227 Fax: +1-248-5517581
Received: January 9, 2017
Peer-review started: January 11, 2017
First decision: February 20, 2017
Revised: May 20, 2017
Accepted: June 12, 2017
Article in press: June 13, 2017
Published online: October 16, 2017
Processing time: 277 Days and 0.6 Hours
Core Tip

Core tip: After Roux-en-Y-gastric-bypass (RYGB) surgery, the surgically excluded distal stomach/duodenum may be difficult to intubate and examine during esophagogastroduodenoscopy (EGD). Two cases are reported of acute upper gastrointestinal (UGI) bleeding many years after RYGB surgery, in which EGD was non-diagnostic due to failure to intubate these excluded segments. However, single balloon or push enteroscopy successfully permitted this intubation, enabling endoscopic diagnosis and therapy of bulbar ulcers at high risk of rebleeding. These case reports suggest using single balloon or push enteroscopy to endoscopically evaluate acute UGI bleeding in patients status-post-RYGB-surgery when EGD was non-diagnostic because of failure to intubate the excluded gastroduodenal segments.