Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Endoscopic ultrasound-guided gastrojejunostomy with a direct technique without previous intestinal filling using a tubular fully covered self-expandable metallic stent

  • Hakan Senturk (Department of Gastroenterology, Bezmialem Vakif University Medicine Faculty) ;
  • Ibrahim Hakki Koker (Department of Gastroenterology, Baskent University Istanbul Hospital, Baskent University Medicine Faculty) ;
  • Koray Kochan (Department of Gastroenterology, Bezmialem Vakif University Medicine Faculty) ;
  • Sercan Kiremitci (Gastroenterology Clinic, Nevsehir Training and Education Hospital) ;
  • Gulseren Seven (Department of Gastroenterology, Bezmialem Vakif University Medicine Faculty) ;
  • Ali Tuzun Ince (Department of Gastroenterology, Bezmialem Vakif University Medicine Faculty)
  • Received : 2023.01.16
  • Accepted : 2023.02.28
  • Published : 2024.03.30
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Abstract

Background/Aims: Endoscopic ultrasonography-guided gastrojejunostomy is a minimally invasive method for the management of gastric outlet obstruction. Conventionally, a lumen-apposing metal stent (LAMS) is used to create an anastomosis. However, LAMS is expensive and not widely available. In this report, we described a tubular fully covered self-expandable metallic stent (T-FCSEMS) for this purpose. Methods: Twenty-one patients (15 men [71.4%]; median age, 66 years; range, 40-87 years) were included in this study. A total of 19 malignant (12 pancreatic, 6 gastric, and 1 metastatic rectal cancer) and 2 benign cases were observed. The proximal jejunum was punctured with a 19 G needle. The stomach and jejunum walls were dilated with a 6 F cystotome, and a 20×80 mm polytetrafluoroethylene T-FCSEMS (Hilzo) was deployed. Oral feeding was initiated after 12 to 18 hours and solid foods after 48 hours. Results: The median procedure time was 33 minutes (range, 23-55 minutes). After two weeks, 19 patients tolerated oral feeding. In patients with malignancy, the median survival time was 118 days (range, 41-194 days). No serious complications or deaths occurred. All patients with malignancy tolerated oral food intake until they expired. Conclusions: T-FCSEMS is safe and effective. This stent should be considered as an alternative to LAMS for gastric outlet obstruction.

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References

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