Post written by Yen-I Chen, MD, MSc, and Ali Bessissow, MD, from McGill University Health Centre, Montreal, Quebec, Canada.

Our video illustrates the use of a novel through-the-scope exchangeable dual-balloon catheter (DUBX, Naja; Chess Medical, Montreal, Quebec, Canada) to assist EUS-guided gastroenterostomy (EUS-GE) in malignant gastric outlet obstruction. Our case shows the streamline through-the-scope insertion of the catheter and its detachable and attachable proximal hub with a plurality of infusion lumens, allowing for scope exchange while keeping the catheter at the desired small-bowel target.

The dual-balloon system provided optimal targeted enteroclysis and small-bowel distension, giving a stable and large space for EUS-guided cautery-assisted insertion of a 20-mm x 10-mm lumen-apposing metal stent (LAMS). Optimal targeted bowel distension allowed the LAMS to be inserted without bowel movement or wall tenting during stent advancement, thereby, keeping excellent EUS views of the LAMS’s cautery tip throughout while facilitating distal flange deployment, leading to secure gastroenterostomy.

EUS-GE is gaining traction as the superior modality for malignant gastric outlet obstruction. However, a standardized, controlled technique is lacking. Our case demonstrates an efficient and adoptable approach to EUS-GE using an assist device that is simple yet elegantly complex in engineering. This novel catheter has the potential to provide a secure and standardized technique to democratize EUS-GE beyond the walls of expert centers and prevent adverse events such as stent misdeployments.

A through-the-scope dual-balloon enteroclysis catheter can greatly facilitate EUS-guided LAMS insertion in EUS-GE with optimal control and ease without sacrificing procedure efficiency.

A, Working hub detached from proximal tip of the enteroclysis catheter. B, Working hub attached to proximal tip of the enteroclysis catheter. C, Inflation of both the distal and proximal balloon to 50 mm with enteroclysis infusion skives located between the 2 balloons.

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