ASGE 2023 Masterclass EUS: Principles, Best Practices & Innovative Paradigms (Virtual) | February 2023-EUS Guided Biliary Drainage and Gastrojejunal Anastomosis

Video Transcription

Video Summary

The video discusses EOS-guided biliary drainage (BD) and gastroenterostomy (GE). For BD, common indications include failed ERCP and inaccessible ampulla. Two main access points for BD are transduodenal and transhepatic. Techniques such as choledochoduodenostomy and rendezvous are performed using linear EUS, CO2, fluoroscopy, and guide wires. The type of stent used depends on the location and length required. EUS BD can be used as a primary method in surgically altered anatomy and gastric outlet obstruction. For GE, techniques include anti-grade stenting, rendezvous, retrograde enterogastrostomy, E-PAS, and direct puncture. EUS-GE is a treatment modality for gastric outlet obstruction. Lumen-opposing metallic stents are recommended. The video also discusses the performance and success rates of EUS-GE compared to other treatments. Complications and pitfalls are mentioned, such as missed puncture and misplacement of stents. EUS-GE can be performed in malignant and benign conditions and requires expertise. Proper scope position, stent selection, and technique are important. Saline mixed with methylene blue is used for visualization during EUS-GE. The procedure can be done under general anesthesia or deep sedation.

Keywords

EOS-guided biliary drainage

gastroenterostomy

transduodenal access

transhepatic access

choledochoduodenostomy

rendezvous technique