Novel EUS-guided gastrojejunostomy technique

Dr. Takao ItoiTakao Itoi, MD, PhD, FASGE from the Tokyo Medical University in Tokyo, Japan discusses his article “Novel EUS-guided gastrojejunostomy technique using a new double-balloon enteric tube and lumen-apposing metal stent (with videos)” from the New Methods section of the December issue.

Advanced gastric, duodenal, and peri-pancreatic cancers can show gastric outlet obstruction (GOO) at the end stage. Surgical gastrojejunostomy is one treatment option, but it is associated with substantial morbidity and mortality when patients are in poor clinical condition. To date, several investigators have described EUS-guided gastrojejunostomy in pigs using a compression button and lumen-apposing metal stent (10-mm in inner diameter). In these studies, techniques for the small bowel with and without a water-filled balloon catheter, and special devices, such as a tilt-tag or an anchor wire, were used for the detection of the targeted small bowel and apposition of the stomach and small bowel, respectively. However, ideally it was mandatory to make the small bowel distended for a safe and reliable procedure. In this study, we developed a unique and novel technique using a double-balloon enteric tube and lumen-apposing metal stent for EUS-guided gastrojejunostomy. To confirm the safety and effectiveness of this technique, we performed the survival study in 5 pig models.

Figure 2Double-reflected nitinol metal stent (SPAXUS stent).

All stents were successfully deployed without any adverse events. All animals showed normal eating behavior without signs of infection for one month after the procedure. Endoscopic imaging at the stomach site showed the stent to be patent and stable, without dislodgement, in all the pigs. Necropsy showed complete adhesion between the stomach and the jejunum wall.

We demonstrated the highly technical and clinical success of a novel EUS-guided gastrojejunostomy technique in pigs using a unique enteric double-balloon tube and a novel reflected metal stent. This is the first technique and may be a milestone for EUS-guided gastrojejunostomy, which appears to be promising as a minimally invasive treatment although there are several challenges in carrying out clinical trials in selected patients. A double-reflected nitinol metal stent was placed between the stomach and the jejunum.

Figure 5Schema of EUS-guided gastrojejunostomy. A, A 19-gauge needle was advanced into the dilated small intestine and filled with saline solution. B, A double-reflected nitinol metal stent was placed between the stomach and the jejunum.

Read this article on page 934-939 of the print journal or find the abstract online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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