EUS-guided gastroenterostomy using direct needle-puncture technique.

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Surgical Innovation

Background:

• Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a recognized treatment for gastric outlet obstruction.
• Existing EUS-GE techniques often require guidewire passage beyond the obstruction, which can be challenging or impossible.
• A need exists for alternative EUS-GE methods applicable when guidewire passage is not feasible.

Purpose of the Study:

• To describe and evaluate a direct needle-puncture technique for EUS-GE.
• To demonstrate the feasibility of EUS-GE creation without relying on guidewire passage.
• To present the application of this technique in challenging clinical scenarios.

Main Methods:

• A direct needle-puncture technique was employed using an echoendoscope positioned in the stomach.
• A 19-gauge needle was used to puncture the gastric and small bowel walls for access.
• The small bowel was distended with fluid, followed by placement of a lumen-apposing metal stent (LAMS).

Main Results:

• The direct needle-puncture technique was successfully performed in 4 patients.
• Indications included postsurgical inflammation, tumor infiltration causing gastric outlet obstruction, and access in altered anatomy.
• The technique allowed for gastroenterostomy creation without guidewire manipulation.

Conclusions:

• The direct needle-puncture technique offers a viable alternative for EUS-GE when guidewire passage is impeded.
• This method is also beneficial for accessing specific bowel segments in patients with altered anatomy.
• It expands the utility of EUS for complex gastrointestinal interventions.