Abstract
An 86 yr old female presents for management of gastric outlet obstruction (GOO) secondary to locally advanced pancreatic adenocarcinoma. An enteral stent was not possible as a guidewire was unable to pass through the stricture. After a multidiscliplinary meeting, the decision was made to proceed with EUS-guided gastrojejunostomy (EUS-GJ) and lumen opposing stent insertion. EUS-GJ offers the advantage of traditional endoscopic stenting in terms of its minimally-invasive nature while avoiding short patency rates due to recurrent stent obstruction by tumor ingrowth. The advent of lumen opposing metallic stents has made EUS-GJ possible by facilitating apposition of the small bowel to the gastric wall for creation of a gastroenteric anastomosis. These anastomotic stents are fully-covered and are bi-flanged to prevent migration and leakage. Various techniques can be used to create a EUS-GJ and include balloon-assisted and direct access. The balloon-assisted technique aids the operator by providing a target (fluid filled biliary retrieval balloon placed over a stiff guidewire) for transgastric puncture. In this patient, as their was complete duodenal obstruction, only the direct access technique was available. The objectives of this video are to demonstrate a technique of EUS-guided gastrojejunostomy using a lumen opposing metallic stent.
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