A 60 year old female status-post RYGB presented with a perforated gastric ulcer in the excluded stomach which was managed non-operatively. A chronic gastro-cutaneous (GC) fistula resulted. As the patient had a history of multiple previous abdominal surgeries, a non-surgical treatment approach to fistula closure was desired. The patient had undergone previous failed endoscopic attempts. An antegrade double balloon enteroscopy (DBE) demonstrated a stenotic pylorus, likely secondary to chronic inflammatory from previous peptic ulcer disease (SI 1a/b). The pylorus was dilated with 10-12 mm CRE balloon dilator (SI 1c) and the scope was advanced into the excluded stomach where the GC fistula was delineated (SI 2a/b). In an attempt to eliminate outflow obstruction from the stomach and promote healing of the GC fistula, we elected to place a trans-pyloric stent.

中文翻译：

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外管辅助在排除胃中放置管腔对置金属支架

一位 60 岁的女性，RYGB 术后状态，在被排除的胃中出现穿孔性胃溃疡，这是非手术治疗。结果导致慢性胃皮肤 (GC) 瘘管。由于患者之前有多次腹部手术史，因此需要一种非手术治疗方法来闭合瘘管。该患者之前曾尝试过失败的内窥镜检查。顺行双气囊小肠镜 (DBE) 显示幽门狭窄，可能继发于既往消化性溃疡病 (SI 1a/b) 的慢性炎症。用 10-12 毫米 CRE 球囊扩张器 (SI 1c) 扩张幽门，并将内窥镜推进到排除的胃中，在那里描绘 GC 瘘管 (SI 2a/b)。为了消除胃流出道梗阻，促进胃瘘愈合，