Endoscopic Ultrasound-Guided Gastrojejunostomy
1Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, 852A, New York, NY 10032, USA.
Abstract:
Gastric outlet obstruction is a common complication of advanced upper gastrointestinal and pancreatic malignancies. Endoscopic ultrasound (EUS)-guided gastrojejunostomy is a new option that may provide a more durable solution than enteral stenting with shorter recovery time and less cost than surgical gastrojejunostomy. Techniques to perform this procedure include direct EUS-guided puncture and balloon-assisted and free-hand methods. Use of cautery-tipped lumen-apposing metal stent results in higher rates of technical success and shorter procedure times. Prospective studies are needed to compare EUS-gastrojejunostomy with enteral stenting and surgical gastrojejusntomy, and to clarify indications, optimal patient selection, and most appropriate method of technically performing this procedure.
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