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Create a Free AccountProcedures - Endoscopic ultrasound (EUS) - therapeutic
EUS-guided gastroenterostomy for proximal jejunal obstruction: technique modification for more distal upper GI tract obstruction
EUS-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMSs) has emerged as a safe, minimally invasive modality for the treatment of gastric outlet obstruction (GOO).1 Several techniques have been described, including anterograde, retrograde, and balloon-assisted approaches.1-3 The “direct” anterograde method of EUS-GE using a nasobiliary catheter to instill contrast material within the target jejunal loop distal to the obstruction uses fewer steps than other approaches and does not require use of a balloon.Combination of a 19-gauge needle and 0.018-inch guidewire with a Y-connector during endoscopic ultrasound-guided hepaticogastrostomy
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) can be performed by either first injecting the contrast medium or inserting the guidewire. Each method has its advantages and disadvantages. When the contrast medium is injected first, the guidewire can be advanced along the correct pathway by using the obtained image. However, the guidewire is inserted into the needle after imaging, which makes its insertion into the bile duct time consuming. Furthermore, the tip of the needle may shift because of body movement or respiratory fluctuations; therefore, even if contrast administration is successful, guidewire placement might not be accurate.Endoscopic ultrasound-guided gastrojejunostomy with lumen-apposing metal stent in a boy with neurological impairment requiring jejunal feeding
Significant undernutrition is reported in 13% to 52% of children with neurodevelopmental disabilities (NPDC).1,2 Oropharyngeal dysphagia (90%), gastroesophageal reflux (50%-75%), delayed gastric emptying (67%), and/or ineffective esophageal peristalsis (61%) are associated with undernutrition. Moreover, nearly all NPDC have 1 or more comorbidity that negatively affects feeding and worsens GI symptoms such as retching and bloating, requiring prompt gastric decompression.3-5A case of cystic paraduodenal pancreatitis with gastric outlet obstruction: technical pitfalls in EUS-guided gastroenteroanastomosis
Cystic paraduodenal pancreatitis is part of a spectrum of diseases, collectively gathered under the term “paraduodenal pancreatitis,” which involves the area between the duodenum, the pancreatic head, and the common bile duct.1 Although common clinical presentation is constituted by abdominal pain, weight loss, and jaundice, association with gastric outlet obstruction (GOO) has been reported.2 In recent years, the introduction of lumen-apposing metal stents (LAMSs) led to the diffusion of a novel technique to manage GOO.Single-session EUS-guided gastroenterostomy and EUS-guided gallbladder drainage in a patient with concomitant gastric outlet obstruction and acalculous cholecystitis
EUS-guided interventions for cholecystitis and gastric outlet obstruction (GOO) are emerging techniques for high-risk surgical patients.1,2 Compared with percutaneous drainage, EUS-guided gallbladder drainage (EUS-GB) has superior clinical and high technical success rates and limited adverse events.3 Similarly, EUS-guided gastroenterostomy (EUS-GE) for GOO has clinical and technical success rates similar to surgical options, with reduced length of stay, hospital costs, and early resumption of oral intake.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.1-3EUS-guided gastrojejunostomy for benign gastric outlet obstruction in a patient with Whipple anatomy
Although lumen-apposing metal stents (LAMSs) are approved for pancreatic fluid collections, off-label use continues to arise for management of a variety of clinical scenarios. LAMSs have been previously described to facilitate biliary access1 and enteral nutrition via EUS-guided gastroenterostomy in the setting of benign and malignant gastric outlet obstruction (GOO) as an alternative to or step-up therapy from duodenal stent placement.2-5 We describe a case of benign GOO in the setting of Whipple anatomy successfully treated by EUS-guided gastrojejunostomy (GJ) with a LAMS to improve food passage into the efferent limb.Gastric outlet obstruction: when you cannot do an endoscopic gastroenterostomy or enteral stent, try an endoscopic duodenojejunostomy or jejunojejunostomy
Certain situations preclude an endoscopic gastroenterostomy (EUS-GE) or enteral stent placement in gastric outlet obstruction (GOO), leaving patients with the option of a surgical bypass or enteral nutrition beyond the point of obstruction. We present a third option in these situations: an endoscopic duodenojejunostomy (EUS-DJ) or jejunojejunostomy (EUS-JJ).EUS-guided gastroenterostomy: techniques from East to West
Gastric outlet obstruction (GOO) can result from benign and malignant causes.1 Surgical gastroenterostomy has been the treatment of choice for patients with benign and malignant GOO with a good functional status.2 Placement of luminal self-expandable metal stents is currently accepted as the endoscopic treatment of choice for malignant GOO because of its effectiveness and minimally invasive nature.3 The main limitation of luminal stents is the high incidence of recurrent GOO resulting from tumor/tissue ingrowth/overgrowth.Lumen-apposing metal stent for the management of intramural hematoma of the GI tract
GI intramural hematomas are uncommon and usually occur in the esophagus or the duodenum, and in rare cases they occur in the stomach.1 The most common cause is blunt abdominal trauma; other causes include endoscopic interventions, peptic ulcer disease, and pancreatitis; in very rare cases they can occur spontaneously in patients receiving oral anticoagulants.2,3 We present the management of 2 cases of gastric and duodenal intramural hematomas by the use of lumen-apposing metal stents (LAMSs).EUS-guided gastrojejunostomy for relief of gastric outlet obstruction from a large duodenal hematoma
A 44-year-old man with a history of alcoholic pancreatitis presented with 6 weeks of nausea, vomiting, and inability to tolerate oral intake. He reported a preceding fall while intoxicated, resulting in a blunt-force injury to the abdomen. CT demonstrated a pancreatic pseudocyst and large hematoma compressing the second and third portions of the duodenum with gastric outlet obstruction (GOO) (Fig. 1). Surgical consultation suggested that he was not an operative candidate, and total parenteral nutrition (TPN) was initiated.
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