Obesity Surgery, 11, 25-27 © FD-Communications Inc. Obesity Surgery, 11, 2001 25 Background: One problem with Roux-en-Y gastric bypass (RYGBP) is that it leaves the bypassed seg- ment not readily available for endoscopic or radi- ographic examinations. Materials and Methods: Three males, 50, 54 and 64 years old, suffered from repeated, gastrointestinal bleeding of unknown origin requiring transfusion 1/2, 1 and 7 years after RYGBP. Access to the stom- ach was obtained by an ultrasound-guided percuta- neous gastrostomy. Results: We could perform endoscopy, barium studies and gastric acid output measurements through the gastrostomy. Histological gastritis, low acid output and absence of H. pylori infection were found. Conclusion: We were able to exclude severe gas- tric disease in our patients. Key words: Excluded stomach, gastrostomy, acid secre- tion, gastrointestinal bleeding, morbid obesity, gastric bypass, interventional radiology, endoscopy Introduction Roux-en-Y gastric bypass (RYGBP) is frequently used in bariatric surgery due to its proven long- term safety and efficacy. 1-4 However, one problem with this operation is that it leaves the bypassed segment not readily available for radiographic or endoscopic examinations, if such investigations should be clinically indicated at some future occa- sion. A survey of the literature shows that severe dis- ease can affect the bypassed stomach. In one series, 8 out of 3000 patients were found to bleed from acid peptic disease in the bypassed segment. 5 Perforated peptic ulcer has been described in 11 out of 4300 patients, 6 and two patients with gastric cancer have been reported. 7,8 It is an accepted clinical rule that all individuals above the age of 45 with unexplained symptoms from the upper gastrointestinal tract should undergo endoscopy or X-ray studies to rule out malignancy. The fact that conventional gastroscopy is impossible after RYGBP may lead to a delay in the diagnosis of gastric disease. Computed tomog- raphy (CT) has been used, 9 but it can only be expected to detect rather large gastric tumors. Faced with a strong suspicion of gastric malig- nancy, an exploratory laparotomy may be the only reliable way to exclude severe gastric disease. We present a method for investigation of the excluded stomach by endoscopy using interven- tional radiological technique. Materials and Methods Three patients with acute gastrointestinal bleeding after previous RYGBP were studied in detail. They were all men, 50, 54 and 64 years old, respectively. Investigation of the Excluded Stomach after Roux- en-Y Gastric Bypass Magnus Sundbom, MD; Rickard Nyman, MD, PhD 1 ; Hans Hedenström, MD, PhD 2 ; Sven Gustavsson, MD, PhD Department of Surgery, 1 Radiology and 2 Clinical Physiology, University Hospital, Uppsala, Sweden Presented at the Fifth Congress of the International Federation for the Surgery of Obesity, Genoa, September 22, 2000. Reprint requests to: Magnus Sundbom, MD, Department of Surgery, University Hospital, 751 85 Uppsala, Sweden. Tel: +46 18 611 45 34; fax: +46 18 55 68 08; e-mail: magnus.sundbom@kirurgi.uu.se