Korean J Gastroenterol.  2022 Jun;79(6):260-264. 10.4166/kjg.2022.045.

Endoscopic Ultrasonography-guided Gastrojejunostomy for Patients with Gastric Outlet Obstruction and Pyloric Metal Stent Dysfunction

• Kim BS
• Yang SY
• Lee WD
• Song JS
• Yang MA
• Jung GM
• Cho JW
• Kim JW

• KMID: 2530699
• DOI: http://doi.org/10.4166/kjg.2022.045

Abstract

A 52-year-old woman with a gastric outlet obstruction (GOO) caused by pyloric cancer underwent pyloric endoscopic self-expandable metal stent (SEMS) insertion. She presented with abdominal distension 40 days later. The SEMS was dysfunctional, and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) was performed using an endoscopic nasobiliary drainage tube. A 16 mm×31 mm Niti-S ™ HOT SPAXUS™ (TaeWoong Medical, Gimpo, Korea) was inserted successfully between the stomach and the adjacent jejunum. After the procedure, the patient had a good oral intake for more than seven months. GOO is a mechanical obstructive condition caused by various benign and malignant conditions. Traditionally, surgical GJ and SEMS insertion have been used to treat GOOs. EUS-GJ is a feasible treatment option for patients with GOO and a pyloric metal stent dysfunction.

Keyword

Gastric outlet obstruction; Pyloric stenosis; Gastroenterostomy; Endosonography; Stents

Figure

• 

  Fig. 1 Pyloric mass and self-expandable metal stent (SEMS) insertion. (A, B) Endoscopic view of the infiltrating mass at the pylorus. (C) Pyloric SEMS insertion. (D) Simple abdominal radiography indicating gastric outlet obstruction. (E) Previous SEMS dysfunction.

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  Fig. 2 Endoscopic nasobiliary drainage (ENBD) tube-assisted endoscopic ultrasonography-guided gastrojejunostomy. (A) Fluoroscopic view of the ENBD tube placed in the proximal jejunum. (B) Echoendoscopic view showing a 19-gauge needle punctured into the jejunum. (C) Fluoroscopic view of the contrast medium and guidewire in the jejunum. (D) SPAXUS stent insertion into the jejunum along the guidewire. (E) CRE balloon dilatation inside the SPAXUS stent. (F) Endoscopic direct view of the jejunum from the stomach.

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  Fig. 3 Gastrojejunostomy with LAMS. (A) Abdominal radiograph. (B) CT scan. (C) f/u CT scan (4 months later). LAMS, lumen apposing metal stent; CT, computed tomography.

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