Complete duodenal obstruction and EUS-guided gastroenterostomy: What to do? (with video).

Gastroenterostomy using a lumen-apposing metal stent (LAMS) is an effective procedure to solve gastric outlet obstruction, but usually, an oroenteral catheter is necessary for filling the small bowel. [1] What to do in cases of complete obstruction when it is not possible even to advance a guidewire through? The academic purpose of this work was to expose a useful approach that may be considered in this scenario. A 64-year-old woman was referred for a complete duodenal obstruction due to pancreatic adenocarcinoma: first, EUS – guided identification of the collapsed small bowel at the Treitz area, and second, EUS-guided puncture using a 22G needle (without stylet and flushed with saline to avoid air injection), filling contrast and saline into the lumen bowel. A submucosal injection of the enteral wall can be recognized as easy to perform and can help to access nicely the enteral lumen, without doubts and fluoroscopy assistance [