A novel technique for enhancing EUS-guided gastrojejunostomy: the dual-scope method

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Surgical Oncology

Background:

• Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is an emerging treatment for malignant gastric outlet obstruction.
• Conventional methods, like the nasobiliary technique, present challenges including scope exchange and maintaining bowel distension.
• A novel dual-scope approach using an ultraslim gastroscope is introduced to address these limitations.

Purpose of the Study:

• To describe and evaluate a novel dual-scope technique for EUS-GJ.
• To assess the safety and efficacy of this technique in patients with malignant gastric outlet obstruction.

Main Methods:

• A retrospective review of 13 consecutive patients undergoing EUS-GJ with the dual-scope technique (June 2020 - April 2024).
• An ultraslim endoscope was used for continuous bowel infusion beyond the obstruction.
• An echoendoscope was advanced alongside for EUS-guided lumen-apposing metal stent placement.

Main Results:

• The dual-scope technique achieved 100% technical success in 13 patients (mean age 63.8 years).
• Twelve of 13 cases involved malignant gastric outlet obstruction.
• No esophageal dilation or trauma occurred; one case of pneumoperitoneum was managed conservatively.

Conclusions:

• The dual-scope technique is a safe and effective alternative to nasobiliary-assisted EUS-GJ.
• It facilitates continuous, controlled bowel distension without scope exchange.
• This method may simplify EUS-GJ, especially in complex cases.