Commentary

The spectrum of malignant gastrointestinal tract obstruction is broad. Gastric outlet obstruction is now effectively managed by traditional enteral stenting or more recently by endoscopic ultrasound (EUS)-guided gastroenterostomy. However, malignant distal small-bowel obstruction often requires surgical intervention. Here, the authors describe a patient with a preterminal ileum obstruction that was successfully treated with an EUS-guided coloenterostomy. The challenges in this scenario are threefold. First, the distal location of the stricture necessitates echoendoscope passage transanally, or alternatively via a colostomy as in this case. Second, the most distal small-bowel loop needs to be identified from multiple surrounding dilated loops. Importantly, while contrast and methylene blue is usually used to mark the target organ, here it marks the proximal small bowel which is intentionally avoided in preference of more distal loops. Finally, the small bowel is a mobile structure of relatively small diameter. Nevertheless, the authors expertly bypass these issues, thereby providing a valuable alternative for palliation of malignant distal small-bowel obstruction that avoids the morbidities of surgery. Although a venting gastrostomy and parenteral nutrition would have been a valid alternative, it would probably have constituted significant impairment to the patient’s quality of life.

Publication History

Article published online:
26 October 2021