“Through-stent enterography”: first experience with a novel technique intended to improve safety in endosonography-guided gastroenterostomy (with video)

Abstract

Background and AimsEndosonographic-guided gastroenterostomy (EUS-GE) is a novel technique to manage symptoms of gastric outlet obstruction. Major challenges are the high mobility of intestinal loops and the transient loss of endosonographic visibility during the puncture. This can lead to stent-misdeployment, which can be associated with potentially fatal adverse events. By injecting contrast medium through the guidewire-channel of the lumen apposing metal stent (LAMS) application system under fluoroscopic guidance, a positive enterogram can confirm the position of the stent inside the intestinal lumen before its deployment. The aim of this study was to describe this novel technique and to assess its feasibility. MethodsThe data of 39 consecutive patients undergoing EUS-GE with “through-stent-enterography” between July 2020 and March 2022 were retrospectively collected and analyzed. Primary endpoint was to assess the technical success. Secondary endpoints were to assess adverse events, rate of reinterventions and clinical success. ResultsTechnical success was achieved in all cases (n=39). In two cases a second puncture was required to place the stent successfully. In one case, misdeployment could be avoided after a negative enterogram. In the other case, misdeployment occurred despite a positive enterogram a reintervention was needed. Clinical success was achieved in 92.3% (n=36). No major adverse events or mortalities were encountered. Conclusions“Through-stent-enterography” after the puncture to confirm the correct position of the stent in the small bowel is a novel and simple technique, which can potentially reduce the risk of misdepolyment of the stent.