Our patient, a 58-year-old woman, was being followed-up for ulcerative colitis. Computed
tomography (CT) showed the presence of a pancreatic nodule, which after endoscopic
ultrasonography (EUS)-guided puncture and biopsy was diagnosed as pancreatic head
adenocarcinoma. The patient developed jaundice and acute cholangitis, and biliary
drainage by endoscopic retrograde cholangiopancreatography was carried out.
One month later, the disease had progressed, with duodenal invasion and obstructive
symptoms. Endoscopic palliation of the obstructive symptoms was opted for with EUS-guided
double-balloon-occluded gastrojejunostomy bypass (EPASS) using a unique double-balloon
tube (Tokyo Medical University type; Create Medic, Yokohama, Japan) and a novel electrocautery-tipped
stent delivery system equipped with a lumen-apposing metal stent (Hot Axios stent;
Boston Scientific, Marlborough, Massachusetts, USA) ([Fig. 1]). At follow-up, the patient presented good resolution of the obstructive symptoms
and was referred for continuation of chemotherapy ([Video 1]).
Fig. 1 a–d Procedure for endoscopic ultrasonography (EUS)-guided double-balloon-occluded gastrojejunostomy
bypass (EPASS). a The guidewire is positioned. b EUS shows a distended jejunum. c Endoscopic imaging shows the distal flange of the biflanged lumen-apposing metal
stent in the jejunum. d Stent in place between the stomach and the jejunum.
Video 1 Endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass
(EPASS) for malignant gastric outlet obstruction.
Surgical gastrojejunostomy, which has been the standard palliative treatment for malignant
obstruction of the gastric outlet, is associated with good functional outcome and
long-term relief of symptoms [1]
[2]. Endoscopic placement of a metal stent has been gaining popularity as an alternative
to surgical gastrojejunostomy to treat malignant obstruction of the gastric outlet,
because of its high technical success rates and lower degree of invasiveness [3].
To sum up, we established the feasibility of an EUS-guided gastrojejunostomy technique
using a unique double-balloon tube and a novel electrocautery-tipped stent delivery
system equipped with a lumen-apposing metal stent.
Endoscopy_UCTN_Code_TTT_1AS_2AB
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in gastroenterological endoscopy. All papers include a high quality video and all
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