Intraoperative gastrojejunoscopy-assisted fistulojejunostomy for postoperative pancreatic fistula

Gastrojejunoscopy facilitates placement of a percutaneous transgastric jejunostomy in a patient with a pancreaticoduodenectomy and multiple-failed feeding tube placements

Enteral access is one of the most common procedures performed in abdominal and interventional radiology. The surgical anatomy of the postoperative stomach may, however, make enteral access challenging. This report describes a patient with a pancreaticoduodenectomy complicated by a gastrojejunostomy leak who underwent 2 unsuccessful transoral endoscopic nasojejunal tube placements and 2 failed percutaneous gastrojejunostomy tube placements. Eventually, a gastrojejunostomy tube was placed utilizing percutaneous techniques with fluoroscopy assistance and gastrojejunoscopy guidance. A combined technique with fluoroscopy and endoscopy, both controlled by interventional radiology, may be useful in patients with complex postsurgical gastrointestinal anatomy who require enteral access.