Ryan Law, DO, from the Division of Gastroenterology at the University of Michigan in Ann Arbor, Michigan, USA, presents this VideoGIE case, “EUS-guided gastroduodenostomy for gastric outlet obstruction related to chronic pancreatitis.”
We present a patient with gastric outlet obstruction from chronic pancreatitis who underwent EUS-guided gastroduodenostomy to relieve her obstruction. Her CT scan demonstrated near apposition of the posterior gastric wall and distal duodenum. A pediatric colonoscope was advanced beyond the obstruction and a guidewire was placed into the jejunum. After colonoscope withdrawal, a dilating balloon was passed over the guidewire to the distal duodenum and inflated. An echoendoscope was passed into the stomach alongside the balloon catheter and the inflated balloon was identified and punctured using an EUS-FNA needle. After confirmation of entry into the small bowel, a second guidewire was passed through the needle into the small bowel. A gastroenterotomy was created and a biflanged lumen apposing stent was deployed. No intra- or post-procedure adverse events occurred. The patient remains clinically well, is tolerating an unlimited diet and has increased her weight >10lbs since the procedure.
This video case report provides further evidence of the evolving therapeutic interventions possible with EUS. While initially developed as a diagnostic tool, EUS continues to evolve to include more interventional procedures.
This case demonstrates a safe and successful endoscopic solution in a patient who otherwise would have required surgical intervention. While successful in this patient, this procedure requires further study and should only be performed by expert therapeutic endoscopists after thorough discussion of the risks, benefits, and alternatives. Additionally, this technique requires favorable anatomy allowing guidewire and endoscopic balloon passage beyond the obstruction.
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