Clement Wu. Good afternoon, everyone. I'm Clement, Therapeutic Endoscopy Fellow from Hopkins. Thank you very much for the opportunity to present my case. I'm actually quite honored to be presenting on behalf of my team. So these are our disclosures. So EUS gastroenterostomy is an accepted treatment modality for malignant gastric obstruction. EUS gastroecolostomy, however, is rarely performed intentionally as a bypass procedure. So in patients with small bowel failure secondary to mesenteric infarction, EUS gastric colostomy is a minimally invasive method of restoring intestinal transit and improving quality of life. So a 33-year-old male with locally advanced pancreatic cancer underwent WIPO procedure with reconstruction of SMA. Unfortunately, he developed small bowel infarction due to failure of the SMA graft, and the patient actually required extensive bowel resection. He became TPN dependent, and he also developed a gastrocutaneous fistula with a superficial collection, resulting in poor quality of life. As the patient was not keen for surgical bypass, EUS gastrocolostomy was performed with the goal of improving quality of life by enabling oral pleasure feeding, by restoring intestinal transit, and also to facilitate fistula closure by diverting the chyme stream and decreasing the fistula output. So as you can see here on the CT scan, we can see a superficial collection together with the fistula. 500 mils of contrast solution was infused in the colon. The linear echo endoscope was placed adjacent to the opacified loop of colon, and the dilated loop of the transverse colon was seen opposing the stomach here. We measured the distance between the stomach and the loop of colon. Cross-doppler flow confirms the absence of blood vessels, and we punctured the dilated loop of colon. And we deployed the lumen-opposing metastand to create a gastrocolostomy. Contrast solution can be seen flowing swiftly to the stomach through the lambs from the colon. And thereafter, we dilated the lumen-opposing metastand to 15 millimeters. And the daily gastrocutaneous fistula output decreased significantly post-procedure, and the patient was able to tolerate liquid diet within 24 hours post-procedure. So we can see here that the gastrocutaneous fistula output decreased significantly post-procedure, 24 hours post-procedure. The patient subsequently underwent percutaneous closure of the gastrocutaneous fistula. There was a significant decrease in the size of the perifistula collection one week post-procedure. And the gastrocutaneous fistula and the associated collection can be seen in the cross-sectional imaging performed post-procedure. So EUS gastrocolostomy offers a minimally invasive option for improving quality of life in select patients with small bowel failure. The diversion of chyme flow and restoration of intestinal transit improves the quality of life in these patients. This case actually illustrates the key role of EUS interventions in improving the quality of life of our patients. And as with all interventional EUS procedures, a multidisciplinary approach is key for success. Thank you very much for your kind attention. Yes, Dr. Kwon. Post-procedure diet. Sorry? Post-procedure diet. There actually wasn't any restriction to his diet. So he pretty much had a low, I mean, basically a post-procedure stenting diet just to make sure that the lumen-opposing metal stent doesn't get occluded. But basically, he was able to have pretty much anything. And this was actually more for pleasure feeding rather than for him to get his nutritional requirements because, basically, because of the surgical procedure, his entire small, all of his small bowel was gone. Yes, so, well, we, there wasn't a plan, there wasn't a follow-up, there wasn't a planned follow-up duration, per se, but unfortunately, in this case, three months, three months after his WIPO, his extended WIPO procedure, they found liver metastases, so he unfortunately passed away a few months, a few months after the procedure. But thankfully, there were no, there were no stent-related adverse events that happened, and at least he was able to spend the last few months of his life with reasonable quality of life. Great discussion. Thank you.

EUS gastrocolostomy

pancreatic cancer

minimally invasive

quality of life

gastrocutaneous fistula