Interventional Endoscopic Ultrasound (EUS) (on demand)-Interventional Endoscopic Ultrasound Case

Video Transcription

Video Summary

Dr. David Lauren presented a 64-year-old woman with persistent inability to eat after a Whipple procedure for duodenal cancer. Imaging showed a dilated stomach without recurrence, and endoscopy found sharp angulation of the efferent limb. The panel considered conservative care, jejunal feeding, stenting, surgical reconstruction, and EUS-guided gastroenterostomy (EUS-GJ). They favored bypassing the obstruction over efferent-limb stenting, which can migrate or fail.<br /><br />Pre-procedure CT review is essential to identify colon and assess the potential window, though anatomy may look different during the procedure. In this case, marked tension on the stomach and concerns about safe deployment led Lauren to abort—an important reminder that stopping is appropriate when conditions are unsafe.<br /><br />The discussion emphasized good visualization, stable scope position, careful cautery advancement, attention to tactile feedback, and troubleshooting without panic or major movement. Participants discussed contrast delivery, including nasojejunal tubes and double-balloon systems, which can distend and stabilize the target bowel. Ascites requires individualized risk assessment; drainage, antibiotics, and a low threshold to abort may be considered.

Asset Subtitle

David Loren, MD, FASGE

Meta Tag

Concept Endoscopic Ultrasound-Guided Gastroenterostomy

Concept Gastric Outlet Obstruction

Concept Cross-Sectional Imaging

Concept Target bowel loop

Concept Lumen-Apposing Metal Stent

Keywords

Whipple procedure

duodenal cancer

efferent limb obstruction

EUS-guided gastroenterostomy

stent migration

pre-procedure CT review

ascites management

CT pre-procedure planning