Case of successful endoscopic ultrasonography‐guided gastrojejunostomy for gastric outlet obstruction caused by gallbladder carcinoma

Tsuchiya, Takayoshi; Sofuni, Atsushi; Itoi, Takao

doi:10.1111/den.13360

Cited by 7 publications

(6 citation statements)

References 4 publications

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“…Only procedure time has been different favoring the direct approach [ 14 ]. The “EPASS”-procedure (EUS-guided double-balloon-occluded gastrojejunostomy bypass), which uses a double-balloon-guided occlusion of the jejunal part which will then be connected to the gastric cavity via LAMS, was recently described as one of the safest approaches [ 15 , 16 ] because of the stable fixation which thereby helps to avoid malpositioning or unsafe LAMS deployment. As for now, it remains in the hands of the endoscopist, which kind of treatment approach to choose, mostly depending on his own experience.…”

Section: Discussionmentioning

confidence: 99%

Hybrid gastroenterostomy using a lumen-apposing metal stent: a case report focusing on misdeployment and systematic review of the current literature

Fabbri¹,

Binda²,

Fugazzola

et al. 2022

World J Emerg Surg

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Background Gastric outlet obstruction can result from several benign and malignant diseases, in particular gastric, duodenal or pancreatic tumors. Surgical gastroenterostomy and enteral endoscopic stenting have represented effective therapeutic options, although recently endoscopic ultrasound-guided gastroenterostomy using lumen-apposing metal stent (LAMS) is spreading improving the outcome of this condition. However, this procedure, although mini-invasive, is burdened with not negligible complications, including misdeployment. Main body We report the case of a 60-year-old male with gastric outlet obstruction who underwent ultrasound-guided gastroenterostomy using LAMS. The procedure was complicated by LAMS misdeployment being managed by laparoscopy-assisted placement of a second LAMS. We performed a systematic review in order to identify all reported cases of misdeployment in EUS-GE and their management. The literature shows that misdeployment occurs in up to 10% of all EUS-GE procedures with a wide spectrum of possible strategies of treatment. Conclusion The here reported hybrid technique may offer an innovative strategy to manage LAMS misdeployment when this occurs. Moreover, a hybrid approach may be valuable to overcome this complication, especially in early phases of training of EUS-guided gastroenterostomy.

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Section: Discussionmentioning

confidence: 99%

Hybrid gastroenterostomy using a lumen-apposing metal stent: a case report focusing on misdeployment and systematic review of the current literature

Fabbri¹,

Binda²,

Fugazzola

et al. 2022

World J Emerg Surg

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“…Endoscopic ultrasonography-guided gastrojejunostomy (EUS-GJ) has been described as an available alternative for the management of GOO [ 12 ]. EUS-GJ implies the transgastric identification of the jejunum distal to the obstruction and subsequent creation of a gastro-enteric anastomosis [ 60 ].…”

Section: Gastric Outlet Obstruction (Goo)mentioning

confidence: 99%

“…The involvement of the main biliary duct can determine the occurrence of jaundice and cholangitis [ 11 ]. Moreover, the close anatomical connection of the gallbladder with the gastrointestinal tube can lead to gastric or intestinal obstruction [ 12 ]. Finally, the pathological involvement of neurological structures such as the celiac plexus can be responsible for severe abdominal pain requiring medical or surgical management [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Palliation in Gallbladder Cancer: The Role of Gastrointestinal Endoscopy

Schepis

Boškoski

Tringali

et al. 2022

Cancers

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Gallbladder cancer is a rare malignancy burdened by poor prognosis with an estimated 5-year survival of 5% to 13% due to late presentation, early infiltration of surrounding tissues, and lack of successful treatments. The only curative approach is surgery; however, more than 50% of cases are unresectable at the time of diagnosis. Endoscopy represents, together with surgery and chemotherapy, an available palliative option in advanced gallbladder cancers not eligible for curative treatments. Cholangitis, jaundice, gastric outlet obstruction, and pain are common complications of advanced gallbladder cancer that may need endoscopic management in order to improve the overall survival and the patients’ quality of life. Endoscopic biliary drainage is frequently performed to manage cholangitis and jaundice. ERCP is generally the preferred technique allowing the placement of a plastic stent or a self-expandable metal stent depending on the singular clinical case. EUS-guided biliary drainage is an available alternative for patients not amenable to ERCP drainage (e.g., altered anatomy). Gastric outlet obstruction is another rare complication of gallbladder malignancy growing in contact with the duodenal wall and causing its compression. Endoscopy is a less invasive alternative to surgery, offering different options such as an intraluminal self-expandable metal stent or EUS-guided gastroenteroanastomosis. Abdominal pain associated with cancer progression is generally managed with medical treatments; however, for incoercible pain, EUS-guided celiac plexus neurolysis has been described as an effective and safe treatment. Locoregional treatments, such as radiofrequency ablation (RFA), photodynamic therapy (PDT), and intraluminal brachytherapy (IBT), have been described in the control of disease progression; however, their role in daily clinical practice has not been established yet. The aim of this study is to perform a review of the literature in order to assess the role of endoscopy and the available techniques in the palliative therapy of advanced gallbladder malignancy.

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“…Only procedure time has been different favoring the direct approach [13]. The "EPASS"-procedure (EUS-guided double-balloon-occluded gastrojejunostomy bypass), which uses a double balloon guided occlusion of the jejunal part which will then be connected to the gastric cavity via LAMS, was recently described as one of the safest approaches [14,15] because of the stable xation which thereby helps to avoid malpositioning or unsafe LAMS deployment. As for now, it remains in the hands of the endoscopist, which kind of treatment approach to choose, mostly depending on his own experience.…”

Section: Case Presentationmentioning

confidence: 99%

Hybrid Gastroenterostomy Using A Lumen-Apposing Metal Stent: A Case Report Focusing On Misdeployment.

Fabbri

Binda²,

Fugazzola

et al. 2021

Preprint

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BackgroundGastric outlet obstruction can result from several benign and malignant diseases, in particular gastric, duodenal or pancreatic tumors. Historically, surgical gastroenterostomy and enteral endoscopic stenting have represented effective therapeutic options. However, surgery is burdened by high complication and mortality rates, while endoscopic stenting demonstrates unsatisfactory patency after six months. Lately, endoscopic ultrasound-guided gastroenterostomy using lumen apposing metal stent (LAMS) is spreading in order to improve the outcome of this condition, but still complication rate remains not negligible. Our case report shows a hybrid (endoscopic and surgical) technique for LAMS deployment, reviews current literature on potential complications and demonstrates problem solving strategies. Case presentationA 60 year-old male patient, affected by metastatic pancreatic adenocarcinoma, developed gastric outlet obstruction due to a duodenal bulb stenosis. Endoscopic ultrasound-guided gastroenterostomy was performed in an operating room, but the first flange of LAMS was misdeployed opening in the epiploon retrocavity. Immediate diagnostic laparoscopy was carried out, LAMS was removed endoscopically and the first jejunal loop was identified by laparoscopy. The jejunal loop was placed near the stomach, allowing for endoscopic release of a second LAMS through the previous fistulous gastric tract, performing a laparoscopy-assisted gastroenterostomy.ConclusionsThis hybrid technique may offer an innovative strategy to overcome misdeployment of LAMS, which represents the most troubling complication of endoscopic ultrasound-guided approach. There are several significant advantages, such as the easy visualization of target loop and cystostome penetration, nevertheless the ability to considerably shorten overall procedure time.

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Case of successful endoscopic ultrasonography‐guided gastrojejunostomy for gastric outlet obstruction caused by gallbladder carcinoma

Cited by 7 publications

References 4 publications

Hybrid gastroenterostomy using a lumen-apposing metal stent: a case report focusing on misdeployment and systematic review of the current literature

Hybrid gastroenterostomy using a lumen-apposing metal stent: a case report focusing on misdeployment and systematic review of the current literature

Palliation in Gallbladder Cancer: The Role of Gastrointestinal Endoscopy

Hybrid Gastroenterostomy Using A Lumen-Apposing Metal Stent: A Case Report Focusing On Misdeployment.

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