VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
EUS-guided gastrojejunostomy for management of complete gastric outlet obstruction
Figure 1. Fluoroscopic images during EUS-guided gastrojejunostomy using the direct-access technique. A, Passage of the guidewire into the jejunum. B, Upper GI series on postprocedure day 1 demonstrating a patent stent.
An 86-year-old woman presented for management of gastric outlet obstruction secondary to locally advanced pancreatic adenocarcinoma. An enteral stent was not possible because a guidewire was unable to pass through the stricture. After a multidisciplinary meeting, the decision was made to proceed with EUS-guided gastrojejunostomy and lumen-opposing stent insertion. A linear echoendoscope was inserted into the stomach, and a loop of small bowel in apposition to the stomach was identified. Transgastric puncture of the small-bowel lumen with a 19-gauge needle was performed, and contrast was injected. Small-bowel loops opacified with no downstream obstruction. A guidewire was inserted deep into the small bowel (Fig. 1A,B). The tract was dilated using a needleknife papillotome connected to cautery and a 4-mm dilating balloon. A fully covered, self-expandable, lumenapposing metal stent (15-mm lumen, 10 mm in length, and 24-mm flares) was deployed creating a G-J anastomosis (Video 1, available online at www.giejournal.org). An upper endoscopy at day 7 revealed no residual gastric residue, and a standard gastroscope was able to pass through the stent into the jejunum. EUS-guided gastrojejunostomy using the direct-access technique is technically feasible with the advent of lumen
www.giejournal.org
apposing metal stents. It may be a suitable alternative to surgery in those patients who have failed enteral stent placement.
DISCLOSURE The following author disclosed financial relationships relevant to this publication: M. A. Khashab: Consultant for Boston Scientific, Xlumena, and Olympus America; research support from Cook Medical. All other authors disclosed no financial relationships relevant to this article. Mouen A. Khashab, MD, Alan H. Tieu, MD, Alba Azola, MD, Saowanee Ngamreunphong, MD, Mohamad H. El Zein, MD, Vivek Kumbhari, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA http://dx.doi.org/10.1016/j.gie.2015.05.017
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
EUS-guided gastrojejunostomy for management of complete gastric outlet obstruction
Figure 1. Fluoroscopic images during EUS-guided gastrojejunostomy using the direct-access technique. A, Passage of the guidewire into the jejunum. B, Upper GI series on postprocedure day 1 demonstrating a patent stent.
An 86-year-old woman presented for management of gastric outlet obstruction secondary to locally advanced pancreatic adenocarcinoma. An enteral stent was not possible because a guidewire was unable to pass through the stricture. After a multidisciplinary meeting, the decision was made to proceed with EUS-guided gastrojejunostomy and lumen-opposing stent insertion. A linear echoendoscope was inserted into the stomach, and a loop of small bowel in apposition to the stomach was identified. Transgastric puncture of the small-bowel lumen with a 19-gauge needle was performed, and contrast was injected. Small-bowel loops opacified with no downstream obstruction. A guidewire was inserted deep into the small bowel (Fig. 1A,B). The tract was dilated using a needleknife papillotome connected to cautery and a 4-mm dilating balloon. A fully covered, self-expandable, lumenapposing metal stent (15-mm lumen, 10 mm in length, and 24-mm flares) was deployed creating a G-J anastomosis (Video 1, available online at www.giejournal.org). An upper endoscopy at day 7 revealed no residual gastric residue, and a standard gastroscope was able to pass through the stent into the jejunum. EUS-guided gastrojejunostomy using the direct-access technique is technically feasible with the advent of lumen
www.giejournal.org
apposing metal stents. It may be a suitable alternative to surgery in those patients who have failed enteral stent placement.
DISCLOSURE The following author disclosed financial relationships relevant to this publication: M. A. Khashab: Consultant for Boston Scientific, Xlumena, and Olympus America; research support from Cook Medical. All other authors disclosed no financial relationships relevant to this article. Mouen A. Khashab, MD, Alan H. Tieu, MD, Alba Azola, MD, Saowanee Ngamreunphong, MD, Mohamad H. El Zein, MD, Vivek Kumbhari, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA http://dx.doi.org/10.1016/j.gie.2015.05.017
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
