A176 DOUBLE-BALLOON ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY FOR A MALIGNANT GASTRIC OUTLET OBSTRUCTION: SIMPLIFYING A COMPLEX PROCEDURE
Bibliographic record
Abstract
Abstract Background Endoscopic enteral stenting is the standard of care for gastric outlet obstruction (GOO) despite high risks for stent dysfunction and need for re-intervention. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique that has the potential to decrease the risk of stent dysfunction due to tumor tissue in-/over-growth. EUS-GE; however, is technically challenging thereby limiting its widespread use. Aims To describe the use of the EUS-GE technique in the management of a GOO using a widely available vascular balloon catheter in aims to demonstrate a modified, more accessible approach to EUS-GE. Methods A 76-year-old woman with a suspected distal common bile duct (CBD) cholangiocarcinoma presented with GOO due to extrinsic compression of the duodenum from the CBD mass. After discussion with the patient and family, a decision was undertaken to perform EUS-GE. An enteroscope was inserted to the level of the obstruction. An 0.035 inch x 450 cm guidewire was advanced across the obstruction and into the jejunal loops under fluoroscopy. Two vascular balloon catheters with a compliant balloon diameter reaching up to 46mm (Coda balloon; Cook Medical, Bloomington, Indiana, USA) were placed with the balloons set 10 cm apart. The device was advanced distal to the obstruction over the wire using fluoroscopic guidance. The balloons were then inflated, occluding the distal and proximal ends of the small bowel loop closest to the stomach. This segment was then dilated with infusion of saline and contrast and identified using EUS. An electrocautery-enhanced 15-mm LAMS was then inserted forming the GE. Results The patient’s post-procedure course was uncomplicated and she tolerated a stent diet within 24 hours of the procedure with no recurrent obstruction at 3 months follow-up. Conclusions EUS-GE is a promising modality for GOO. The described case demonstrates that a modified approach using widely available vascular balloon catheters can effectively facilitate the technical aspect of this procedure. Further studies are needed to validate this novel technique. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".