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Related Concept Videos

Endoscopic Procedures I: Esophagogastroduodenoscopy01:29

Endoscopic Procedures I: Esophagogastroduodenoscopy

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An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
During an EGD, the endoscope can be used to:
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Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding01:15

Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding

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Enteral nutrition encompasses various methods of delivering nutrition directly to the gastrointestinal (GI) tract, bypassing traditional oral intake. It is particularly beneficial for patients who cannot eat by mouth but have a functioning digestive system. Key methods include nasointestinal feeding, gastrostomy, and jejunostomy, each suited to different clinical scenarios based on the patient's needs and condition.
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Endoscopic Procedures III: Video Capsule Endoscopy01:28

Endoscopic Procedures III: Video Capsule Endoscopy

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Capsule endoscopy, or wireless or video capsule endoscopy, is a diagnostic procedure for examining the entire gastrointestinal tract. Patients swallow a capsule about the size of a vitamin tablet. The capsule is equipped with a transmitter, a battery, an LED light source, and a color video camera to capture images throughout the gastrointestinal tract. This procedure is particularly useful for diagnosing conditions such as Crohn's disease, ulcerative colitis, tumors, polyps, ulcers,...
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Endoscopic Procedures V: ERCP01:26

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Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
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Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy01:26

Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy

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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
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Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
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Endoscopic Procedures II: Colonoscopy01:25

Endoscopic Procedures II: Colonoscopy

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The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections:
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Related Experiment Video

Updated: Jan 10, 2026

Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
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Published on: August 22, 2025

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Reverse endoscopic ultrasound-guided neogastrojejunostomy.

Jenson Phung1, Nabeel Azeem2

  • 1Department of Internal Medicine, University of Minnesota, Minneapolis Minnesota, USA.

Videogie : an Official Video Journal of the American Society for Gastrointestinal Endoscopy
|November 20, 2025
PubMed
Summary
This summary is machine-generated.

Endoscopic ultrasound (EUS)-guided gastrojejunostomy (GJ) successfully managed a hiatal hernia obstruction after colonic interposition. A reverse approach using a lumen-apposing metal stent (LAMS) improved outcomes and prevented complications.

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Area of Science:

  • Gastroenterology
  • Interventional Endoscopy
  • Surgical Oncology

Background:

  • Endoscopic ultrasound (EUS)-guided gastrojejunostomy (GJ) offers a minimally invasive alternative to surgery for managing upper gastrointestinal obstructions.
  • Hiatal hernias can cause outlet obstruction, particularly in patients with prior gastric surgery and reconstructive procedures like colonic interposition.

Purpose of the Study:

  • To describe a novel application of EUS-guided GJ for managing outlet obstruction secondary to a hiatal hernia in a patient with a colonic interposition.
  • To highlight the utility of a reverse approach for EUS-guided GJ to overcome technical challenges and improve safety.

Main Methods:

  • A 71-year-old female with a history of total gastrectomy and colonic interposition presented with symptoms of gastric outlet obstruction.
  • Initial attempts at stenting the colojojeunal anastomosis failed due to migration; obstruction was attributed to extrinsic compression from a hiatal hernia.
  • EUS-guided neo-GJ was performed, initially with distal flange misdeployment into the peritoneum. The stent was removed, the perforation closed, and a successful reverse approach was utilized.

Main Results:

  • The initial attempt at EUS-guided GJ using a lumen-apposing metal stent (LAMS) resulted in distal flange misdeployment into the peritoneum.
  • Following stent removal and closure of the perforation, a reverse EUS-guided GJ was successfully performed, with the LAMS advanced transjejunally into the neostomach.
  • Oral contrast studies confirmed stent patency, and the patient remained symptom-free at 6-month follow-up.

Conclusions:

  • Misdeployment of LAMS into the peritoneum is a known complication in EUS-guided GJ procedures.
  • A reverse approach for EUS-guided GJ, targeting a less mobile structure, can mitigate the risk of stent displacement and improve procedural success.
  • EUS-guided GJ is a viable option for managing complex outlet obstructions in patients with prior gastric surgery and reconstructive procedures.