Endoscopy 2018; 50(04): S125-S126
DOI: 10.1055/s-0038-1637404
ESGE Days 2018 ePoster Podium presentations
21.04.2018 – EUS Interventional: extreme
Georg Thieme Verlag KG Stuttgart · New York

EUS-GUIDED GASTROJEJUNAL ANASTOMOSES WITH AXIOS® STENT FOR ANASTOMOTIC AFFERENT LOOP OBSTRUCTION A ABOUT 5 CASES WITH VIDEOS

JM Gonzalez
1   Aix-Marseille Univ, Hôpital Nord, AP-HM, Gastroenterology, Marseille, France
,
D Lorenzo
1   Aix-Marseille Univ, Hôpital Nord, AP-HM, Gastroenterology, Marseille, France
,
G Vanbiervliet
2   Hallym University College of Medicineôpital L'Archet 2, CHU de Nice, Gastroenterology, Nice, France
,
M Barthet
1   Aix-Marseille Univ, Hôpital Nord, AP-HM, Gastroenterology, Marseille, France
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Introduction:

EUS-guided gastro-jejunal anastomoses (GJA) are feasible in humans with Axios® stent (Boston Scientific, USA). Several cases have been performed under EUS, directly or using simple or double balloon. We present three cases of direct EUS guided GJA in post-operative anastomotic obstructions.

Patients and methods:

Case 1: 32 years-old women diagnosed with locally advanced pancreatic adenocarcinoma treated by surgical bilio-enteric derivation in December 2014. In August 2015, she presented with occlusion and cholangitis due to anastomotic recurrence.

Case 2: 78 years-old man diagnosed with gastric adenocarcinoma. He underwent inferior polar gastrectomy with GJA and chemotherapy. In June 2016, she had a recurrence with a peritoneal carcinosis nodule obstructing the anastomosis, leading to intestinal occlusion and jaundice.

Case 3: This was a 55 years-old women with resectable pancreatic adenocarcinoma treated by pancreatic duodenectomy. 6 months later, she had occlusive syndrome due to a recurrence in the resection lodge. Procedures: The procedure were performed on patients intubated in supine position, using a therapeutic EUS scope (Pentax, Japan) and C02. After ultrasound detection, the efferent loop was directly punctured with the Hot Axios stent applying section current. The distal flange and then the proximal one were successively deployed.

Results:

Five patients underwent direct EUS-guided GJA. The procedure took 16 to 20 minutes, without complication. Clinical success was achieved in all the cases. There was no post-operative adverse event and all the patients could eat at POD 2 and were discharged at POD 5. During follow-up, one patient died due to a metastatic disease, whereas the four others started a chemotherapy over, with a mean follow-up of 8 months.

Conclusions:

We confirm the feasibility and safety of direct EUS guided GJA, in post-surgical anastomotic obstructions. This is a novel and promising therapeutic alternative for patients, allowing for an immediate resolution of symptoms.