Current status and perspective of endoscopic ultrasonography-guided gastrojejunostomy: endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy (with videos)

Surgical intervention and, more recently, endoscopic intervention have been performed for the treatment of malignant gastric outlet obstruction. Recently, endoscopic ultrasonography (EUS)‐guided gastrojejunostomy using special devices has been established. In line with this, we have developed a nove...

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Published inJournal of hepato-biliary-pancreatic sciences Vol. 22; no. 1; pp. 3 - 11
Main Authors Itoi, Takao, Ishii, Kentaro, Tanaka, Reina, Umeda, Junko, Tonozuka, Ryosuke
Format Journal Article
LanguageEnglish
Published Japan Blackwell Publishing Ltd 01.01.2015
Wiley Subscription Services, Inc
Subjects
Biflanged metal stent
Double-balloon tube
Endoscopic ultrasonography
Endoscopic ultrasonography-guided gastrojejunostomy
Endoscopy
Endosonography - methods
Equipment Design
Gastric Bypass - instrumentation
Gastric Outlet Obstruction - diagnostic imaging
Gastric Outlet Obstruction - surgery
Gastroscopes
Humans
Palliative Care
Surgery, Computer-Assisted - methods
Endoscopic ultrasonography-guided gastrojejunostomy
Biflanged metal stent
Endoscopic ultrasonography
Double-balloon tube
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Summary:Surgical intervention and, more recently, endoscopic intervention have been performed for the treatment of malignant gastric outlet obstruction. Recently, endoscopic ultrasonography (EUS)‐guided gastrojejunostomy using special devices has been established. In line with this, we have developed a novel EUS‐guided double‐balloon‐occluded gastrojejunostomy (EBOG) using a lumen‐apposing biflanged metal stent. Herein, we describe the technique and outcome of EBOG.
Bibliography:ark:/67375/WNG-8KTSBTN5-1
istex:9691AD7670934409D19C4095FF215396C257F000
ArticleID:JHBP148
Video S1 A standard upper GI endoscope is advanced into the third portion of the duodenum. A 0.025-inch stiff guidewire is maximally advanced. Then, the endoscope is removed, leaving the guidewire in place. A double-balloon tube is perorally inserted over the guidewire in combination with a 0.89-inch dedicated guidewire for better torquability, and two balloons are placed in the jejunum across from the stomach. The double balloons are filled with saline and contrast medium to hold the small intestine open.Video S2 Sufficient quantity of saline is introduced into the space between the two balloons. A curved linear array echoendoscope is advanced into the stomach. A 19-gauge fine-needle aspiration needle is used to puncture the jejunum under EUS guidance. A 0.025-inch guidewire is inserted through the 19-gauge needle. After the gastrojejunostomy tract is dilated over the wire using a 6-Fr electrocautery needle and a 6-mm dilating balloon, the delivery catheter is advanced over the guidewire into the jejunum. The stent is deployed across the gastrojejunostomy tract under combined EUS, fluoroscopic, and endoscopic guidance. The distal anchor flange is deployed first under EUS guidance and fluoroscopic guidance. Traction is then applied to appose the distal anchor flange against the inner jejunum wall, positioning the jejunum in firm apposition against the gastric wall. The proximal anchor flange is then deployed under fluoroscopic and endoscopic guidance.
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ISSN:1868-6974
1868-6982
DOI:10.1002/jhbp.148