Dilation balloon-occlusion technique for EUS-guided gastrojejunostomy

eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3YWJhZWU0MTdjNGZlYjI2NTIxMDZjYmM0ZGQ1ZjU2OCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjg3ODA1MzEzfQ.jbZ10PKT4fQJDAS-l5WFwDg9p0SXPq80TMX9zaELKduDGj8Gyhi37KsE80AxbVI_BtgCGEnB3vHf5lTY-awwY9xMrWOUPzG4LYX3v8vOnQsaDqj6Xd7pt0RFxmTD7F98UObClF6H5pEuUgfgV_1oujIzObDIgicXZ8HRsn6Xtm2zVIsz2fCprylOhp_zWxcwPj4ikXy_x2Zi-tBoGyYBiQtBnaSTtdGwQvXGTqy4jOurRVlW697gLVXXBTXFhcmVlIoj39pJsY_YZAZTJAFH8kqSu8k6qqveo1rNgPQ6CXOSorJWnS9QBIh18sABNkEpFJHYYtmMo6MKNaJR2RN1ZA(mp4, (98.04 MB) Download video Dilation balloon-occlusion technique for EUS-guided gastrojejunostomy. gastrojejunostomy (EUS-GJ) offers an alternative treatment to luminal stenting and surgical the of gastric outlet obstruction, particularly in cases secondary malignancy.1Khashab M.A. Kumbhari V. Grimm I.S. et al.EUS-guided gastroenterostomy: first U.S. clinical experience (with video).Gastrointest Endosc. 2015; 82: 932-938Abstract Full Text PDF PubMed Scopus (124) Google Scholar,2Tonozuka R. Tsuchiya T. Mukai S. al.Endoscopic ultrasonography-guided gastroenterostomy techniques malignant obstruction.Clin 2020; 53: 510-518Crossref Scholar The basic premise performing EUS-GJ entails using a lumen-apposing metal stent (LAMS) create connection between stomach small bowel (typically jejunum), thereby creating bypass by which food liquid can enter unobstructed bowel. Recent retrospective data have demonstrated equivalent, if not higher, success rates with comparison duodenal stents significantly lower dysfunction rates.3van Wanrooij R.L.J. Vanella G. Bronswijk M. ultrasound-guided versus obstruction: international, multicenter, propensity score-matched comparison.Endoscopy. 2022; 54: 1023-1031Crossref (16) Scholar,4Sánchez-Aldehuelo Subtil Iñigo J.C. Martínez Moreno B. self-expandable results from nationwide multicenter study 96: 1012-1020.e3Abstract (4) Nevertheless, adverse events remain significant concern this procedure, especially given typically frail patient population who receive treatment. While variety exist EUS-GJ, such as antegrade direct downstream methods EUS balloon-occluded GJ (EPASS) method commonly performed Asia, stable insertion site under good visualization remains challenge requires many different instruments catheter EPASS method, is available United States.5Irani Itoi Baron T.H. east west.VideoGIE. 5: 48-50Abstract (34) We therefore describe simple modification facilitate instruments. obtained informed consent administered 1 dose prophylactic antibiotics at start procedure. Under general anesthesia, was placed prone position used ERCP. premixed 250-mL solution consisting 50% sterile water contrast, plus half vial methylene blue. As Video (available online www.videogie.org), standard gastroscope identify narrowing (Fig. 1). Once identified, long-angled 0.035-inch guidewire (Hydra Jagwire; Boston Scientific, Marlborough, Mass, USA) advanced endoscopic fluoroscopic guidance into jejunum ideally several loops formed. length stenosis determined either contrast injection or pulling back inflated extraction balloon that had been over past stenosis. endoscope then removed while exchange process keep jejunum. An 18- 20-mm dilation (CRE Balloon Dilatation Catheter; Scientific) fluoroscopy assistant maintaining pressure advancement. 20 mm 2). removed. linear echoendoscope side-by-side stomach. irrigation foot pedal connected water, blue attached catheter. endoscopist irrigated through catheter, essentially enterogram 3). This distends prevents backflow proximally agitation jejunal contents during also simplifies identification guidance, suitable LAMS placement identified 4). mg glucagon option giving up 4 mg) and, freehand technique, deployed 15- diameter electrocautery-enhanced (AXIOS; Deployment proximal flange resulted coming stomach, confirming successful placement. After LAMS, visible endoscopically 5).Figure 5Successful deployment stent.View Large Image Figure ViewerDownload Hi-res image (PPT) Stent misdeployment represents most common event occurring 10% cases.6Ghandour Bejjani Irani S.S. al.Classification, outcomes, management misdeployed gastroenterostomy.Gastrointest 95: 80-89Abstract (17) Scholar,7Bejjani Ghandour al.Clinical technical outcomes patients undergoing vs. 15-mm stents.Endoscopy. 680-687Crossref (6) Less include aspiration pneumonia, postoperative infection, small-bowel perforation. window perform enhancing distention allowing its easy identification. facilitates deployment, reduce number required importantly, allows take advantage ideal puncture before moves away (particularly after needle puncture) contracts. Furthermore, preventing less may be required. further needed determine superiority one another, we simplified aid endoscopists offer when other are feasible, cannot obstruction.