Fluoroscopy-guided gastrojejunostomy: A work in progress

Abstract

Surgical gastrojejunostomy (GJ) has traditionally been the mainstay of treatment for malignant gastric outlet obstruction (GOO). However, most patients preferentially choose to undergo self-expandable metal stent (SEMS) placement due to its minimally invasive nature, although it is wellrecognized that surgical GJ is associated with longer patency and less reinterventions than SEMS placement. Endoscopic ultrasound (EUS)-guided GJ has recently emerged as a novel procedure for the treatment of malignant GOO. This procedure offers a non-surgical means of performing GJ, but its widespread use is limited because it could only be performed by experienced endoscopists with expertise in EUS-guided procedures. The authors performed fluoroscopy-guided GJ in eight domestic pigs by puncturing the proximal jejunum from the stomach using a Rösch-Uchida transjugular liver access set followed by the placement of a lumen-apposing metal stent across the puncture tract. The results showed that fluoroscopy-guided GJ may be a technically feasible and simple procedure but, before clinical trials can be undertaken, further technical refinements are required to reduce the risk of inadvertent transgression of non-target organs.

Keywords

• endosonography; gastric bypass; gastric outlet obstruction; prostheses and implants