Percutaneous endoscopic gastrostomy tube insertion via gastro-gastric fistula in a gastric bypass patient.

Enteral feedings are the preferred route of nutritional support for malnourished or critically ill patients. Recent progress in flexible endoscopic and interventional radiological techniques has allowed adaptation of numerous new procedures. Anatomic and functional rearrangement of the gastrointestinal tract often precludes traditional percutaneus endoscopic gastrostomy tube placement. Insertion of a gastroscope through the nose, via open pharynx, or neck fistula have been described, but there are no reports in the English literature describing introduction of the gastroscope through a dilated gastro-gastric fistula in a patient with previous open Roux en Y gastric bypass.