CASE REPORT article
Front. Transplant.
Sec. Abdominal Transplantation
This article is part of the Research TopicEmerging Technologies in Organ Transplantation and Transplantation Oncology: From Basic Research to Clinical ApplicationsView all 5 articles
Case Series: Endoscopic Ultrasound-Guided Direct Trans-Gastric Fistula in Liver Transplant Recipients with Roux-en-Y Gastric Bypass
Provisionally accepted
- 1University of California San Francisco Department of Surgery, San Francisco, United States
- 2University of California San Francisco, San Francisco, United States
- 3University of California San Francisco Department of Medicine, San Francisco, United States
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Introduction: Among liver transplant recipients, Roux-en-Y gastric bypass (RYGB) may lead to postoperative malnutrition and nutrient deficiencies. Procedures such as the endoscopic ultrasound-directed trans-gastric ERCP (EDGE) can result in advantageous weight gain for liver transplant recipients with prior RYGB who do not respond to enteral or parenteral nutritional interventions. Methods: We present three patients who underwent EDGE for post-transplant malnutrition and weight loss. Results: EDGE resulted in weight gain across all patients. Liver transplant recipients with a history of RYGB may be at significant nutritional risk following transplant due to fat malabsorption, underestimation of resting energy expenditure, and appetite suppression mediated by neurohormonal signals. Conclusion: When traditional nutritional interventions are unsuccessful, the EDGE procedure may be an effective alternative to promote post-transplant weight gain in this unique population.
Keywords: Bariatric Surgery, edge, ERCP, Liver Transplantation, Malnutrition
Received: 15 Aug 2025; Accepted: 28 Jan 2026.
Copyright: © 2026 Crest, Navarro, Barry and Roberts. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: John Roberts
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