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Create a Free AccountProcedures - Endoscopic ultrasound (EUS) - therapeutic
EUS-guided gastrojejunostomy for management of malignant gastric outlet obstruction in a patient with Roux-en-Y anatomy
Gastric outlet obstruction is a complication of advanced gastrointestinal malignancies and contributes significantly to patient morbidity. Surgical gastrojejunostomy (GJ) and enteral stenting have been traditionally employed for management in these patients. Endoscopic ultrasound–guided gastrojejunostomy (EUS-GJ) with a lumen-apposing metal stent (LAMS) provides an alternative to luminal stenting and surgical GJ. We present a case of EUS-GJ performed in a patient with Roux-en-Y anatomy.EUS-guided gastrojejunostomy and hepaticogastrostomy for malignant duodenal and biliary obstruction
Malignancies in the upper abdomen can cause both biliary obstruction and gastric outlet obstruction (GOO), leading to acute illness and significant impairment in quality of life. Surgical intervention is invasive and morbid, especially in the presence of malignant ascites. Recent advances in therapeutic EUS-guided techniques have provided minimally invasive approaches to offer these patients relief and palliation.1-3Lessons learned from a salvage procedure for lumen-apposing metal stent misplacement during EUS-guided gastrojejunal bypass
EUS-guided gastrojejunal bypass (EUS-GJ) for treatment of gastric outlet obstruction has been made possible since the advent of lumen-apposing metal stents (LAMSs).1 The interest in this technique has recently grown because of its minimally invasive approach, good functional results, and long-term symptom relief.2Single-step EUS-guided jejunojejunostomy with a lumen-apposing metal stent as treatment for malignant afferent limb syndrome
Afferent limb syndrome (ALS) is a well-recognized delayed adverse event after subtotal gastrectomies and other gastrojejunostomies. ALS is defined as a chronic, mechanical obstruction of the afferent limb (AL), resulting in pancreatobiliary problems. It is more common in long-term survivors (≥2 years) who have undergone pancreaticoduodenectomy (PD) for cancer and adjuvant chemoradiation.1 In fact, among those patients, ALS is more likely to occur because of the long period of time for the radiation effects and cancer recurrence to develop.Luminal and extraluminal bleeding during EUS-guided double-balloon–occluded gastrojejunostomy bypass in benign gastric outlet obstruction with portal hypertension
A 45-year-old man with longstanding idiopathic chronic pancreatitis and splenic venous thrombosis presented with postprandial vomiting and abdominal fullness 10 months earlier. He received a diagnosis of duodenal narrowing (D1-D2 junction) (Fig. 1) and underwent several sessions of endoscopic balloon dilation, with an ill-sustained response. Surgery was attempted elsewhere; however, gastrojejunostomy was not done because of extensive perigastric collaterals. His laboratory evaluation showed moderate anemia (hemoglobin 10 gm/dL), platelets 1.2 lakhs/mm3, prothrombin time 17 seconds (international normalized ratio 1.28) and normal liver function test results, serum amylase levels, and lipase levels.EUS-guided gastrojejunostomy with an esophageal fully covered self-expanding metal stent for the management of benign afferent loop obstruction
A 71-year-old man with a history of ampullary adenocarcinoma (T2N0M0 stage II), who had undergone a pancreaticoduodenectomy (classic Whipple resection) 2 years earlier, presented with acute onset of persistent severe epigastric abdominal pain associated with bilious vomiting. The results of laboratory testing were remarkable for elevated lipase (1183 U/L; reference range 10-80 U/L). The liver biochemical and function test results were within normal limits. A CT scan of the abdomen revealed interstitial edematous pancreatitis and afferent loop dilation with a transition point present (Figs. 1A and B).
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