Double-balloon endoscopic ultrasound-guided gastroenterostomy: simplifying a complex technique towards widespread use
Notice bibliographique
Résumé
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique for the management of gastric outlet obstruction (GOO), which has been shown to be safe and effective [ 1 ] [ 2 ]. To mitigate technical difficulties, a specialized double-balloon catheter was developed in Japan and has been found to be effective when used with an electrocautery-enhanced lumen-apposing metal stent (LAMS) [ 3 ]. Outside of Japan, however, this device is unavailable; therefore, in North America and Europe only highly specialized centers are currently performing EUS-GE using techniques that are challenging and with the potential for severe adverse events. Here we describe the performance of double-balloon EUS-GE using a widely available vascular balloon catheter ([ Video 1 ]). Video 1 Endoscopic ultrasound-guided gastroenterostomy for malignant gastric outlet obstruction facilitated by a double-balloon occlusion device made from a widely available vascular balloon catheter. Quality: mobile 360 480 720 Download A 72-year-old man with unresectable pancreatic cancer presented with recurrent GOO following previous enteral stenting and was found to have stent tumor ingrowth ([ Fig. 1 ]). A multidisciplinary decision was made to attempt EUS-GE facilitated by double-balloon occlusion. A guidewire was endoscopically advanced through the obstructed stent deep into the jejunum. The endoscope was exchanged through an overtube to prevent looping in the stomach. Two vascular balloon catheters with a compliant balloon diameter reaching up to 46 mm when inflated (Coda balloon; Cook Medical, Bloomington, Indiana, USA) were fashioned together with the balloons set 10 cm apart ([ Fig. 2 ]). The device was advanced distal to the obstruction over the wire using fluoroscopic guidance. The balloons were then inflated to anchor the small bowel and saline with contrast was injected through the proximal catheter, filling the bowel lumen between the balloons. On EUS, the bowel segment was visibly dilated and anchored, thereby facilitating stent insertion ([ Fig. 3 ]). An electrocautery-enhanced 15-mm LAMS was then inserted to complete the gastroenterostomy ([ Fig. 4 ]). Fig. 1 Endoscopic view showing enteral stent obstruction caused by pancreatic cancer tumor ingrowth. Fig. 2 A double-balloon occlusion device made by connecting two radiologic vascular balloon catheters with the balloons set 10 cm apart. Fig. 3 Endoscopic ultrasound image of the dilated fluid-filled small-bowel segment between the two occluding balloons. Fig. 4 Fluoroscopic image of the lumen-apposing metal stent anastomosing the stomach to the small bowel distal to the enteral stent. The patient tolerated a stent diet within 24 hours but required endoscopic revision 6 weeks later owing to blockage of the stent by a potassium chloride pill. No further intervention was subsequently required. The use of EUS-GE as a first-line treatment of GOO is limited by technical challenges. The presently described double-balloon EUS-GE greatly facilitated the procedure using a device that is widely available. This may be a first step towards dissemination of this modality and will likely encourage high quality prospective trials to evaluate its role. Endoscopy_UCTN_Code_TTT_1AS_2AG Endoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,003 |
| Communication savante | 0,004 | 0,006 |
| Science ouverte | 0,001 | 0,004 |
| Intégrité de la recherche | 0,002 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».