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Título

ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY FOR TREATMENT OF OUTLET OBSTRUCTION

Resumo

INTRODUCTION
Gastric outlet obstruction (GOO) is commonly a complication of advanced pancreatic, biliary and gastric tumors. Surgical gastrojejunostomy (SGJ) is the standard of care. As these patients are not good surgical candidates, duodenal stent (DS) has been used with limited long-term outcomes. In this context, the endoscopic ultrasound-guided gastroenterostomy (EUS-GE), has emerged as a safe and effective option for palliation of GOO.
CASE REPORT AND PROCEDURE
A 71-year-old man with weight loss and jaundice was diagnosed with advanced adenocarcinoma of the pancreatic head. After biliary drainage with a fully covered metal stent, he was referred to chemotherapy.
The disease progressed and the patient was hospitalized due to persistent vomiting caused by duodenal obstruction. Then, EUS-GE was proposed.
The procedure was performed by passing a double-balloon catheter with guide-wire through the stenosis (Itoi’s balloon). The balloons were inflated with contrast under fluoroscopy guidance and the third duodenal portion was filled with saline solution with indigo carmine. The visualization of the distended small-bowel loop was possible by positioning the echoendoscope into the stomach next the posterior wall. Then, the gastroenterostomy initiated with fistulotomy using pure cut current and introduction of LAMS (lumen apposing metal stent) delivery system through the gastric and small-bowel walls. The distal flange was deployed in the small-bowel and retracted closer to gastric wall, so that the proximal flange was deployed inside the stomach. The correct position of the stent was confirmed by the reflux of the dye into the stomach.
No adverse events were observed. After seven days, he was discharged from hospital on low-residue diet.
DISCUSSION
Some studies show that SGJ and EUS-GE do not present a significant difference in terms of clinical success, but the length of stay is significantly shorter with EUS – GE. Another alternative for palliation of GOO is DS placement. However, it has a high re-intervention rate.
CONCLUSION
This case illustrated how EUS-GE can be a minimally invasive option for treatment of GOO with clinical success, and short hospital stay.