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CC BY 4.0 · Endoscopy 2025; 57(S 01): E818
DOI: 10.1055/a-2641-9546
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Single-balloon enteroscopy-assisted endoscopic ultrasound-guided gastroenterostomy for duodenal ascending part obstruction in stage IV pancreatic tail carcinoma

Xue Sun 
1   Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua, China (Ringgold ID: RIN159410)
,
Xiaoming Wang
1   Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua, China (Ringgold ID: RIN159410)
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A 50-year-old female with stage IV (T4NxM1) pancreatic tail carcinoma presented with gastric outlet obstruction (GOO) symptoms. Abdominal computed tomography demonstrated a stenosis at the junction between the duodenal horizontal part and proximal jejunum. Gastroscopic/colonoscopic localization attempts failed, but single-balloon enteroscopy (SBE; SIF-Q260, Olympus Medical Systems) identified luminal narrowing in the duodenal ascending part near the ligament of Treitz.

Given the patient’s cachectic state precluding surgical intervention, our department attempted SBE-assisted endoscopic ultrasound-guided gastroenterostomy (EUS-GE) ([Video 1]). SBE reached the stenosis orally. Under fluoroscopic guidance, a 7-Fr nasobiliary tube was placed in the distal jejunum over a disposable guidewire for 500 mL methylene blue-stained saline infusion to distend the target segment. EUS identified a dilated jejunal lumen with gastroenteric wall distance <1 cm. A 19-G EUS needle punctured the jejunum to confirm luminal access. A 20 mm × 10 mm lumen-apposing metal stent (LAMS; Axios, Boston Scientific) was deployed at 100-W pure-cut mode.

Single-balloon enteroscopy-assisted endoscopic ultrasound-guided gastroenterostomy for duodenal ascending part obstruction.Video 1

After the procedure, the patient achieved marked palliation of GOO symptoms with a 5-kg weight regain observed within 40 days. Serial barium studies (postoperative day 4 and 2 months) confirmed sustained stent patency. Per treatment protocol, repeat EUS-GE was planned for potential afferent loop syndrome (ALS) secondary to complete stricture of the duodenal ascending part. This would involve creating a gastro-duodenal horizontal part anastomosis to decompress the proximal intestinal lumen. However, ALS did not occur during the follow-up of the patient.

To date, EUS-GE has been predominantly applied to gastric distal and duodenal proximal stenosis [1] [2] [3] [4]. This represents the first documented case of SBE-assisted EUS-GE for duodenal ascending part obstruction secondary to pancreatic tail carcinoma. This case demonstrates the feasibility of SBE-assisted EUS-GE for duodenal ascending part-to-jejunal obstructions, but it is necessary of gastroenteric wall proximity (<1 cm) for safe anastomosis.

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Publication History

Article published online:
25 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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