Fluoroscopy-Guided Gastrojejunostomy: A Work In Progress

Surgical gastrojejunostomy (GJ) has traditionally been the mainstay of treatment for malignant gastric outlet obstruction (GOO). However, most patients preferentially choose to undergo self-expandable metal stent (SEMS) placement due to its minimally invasive nature, although it is well-recognized that surgical GJ is associated with longer patency and less reinterventions than SEMS placement. Endoscopic ultrasound (EUS)-guided GJ has recently emerged as a novel procedure for the treatment of malignant GOO. This procedure offers a non-surgical means of performing GJ, but its widespread use is limited because it could only be performed by experienced endoscopists with expertise in EUS-guided procedures. The authors performed fluoroscopy-guided GJ in eight domestic pigs by puncturing the proximal jejunum from the stomach using a Rosch-Uchida transjugular liver access set followed by the placement of a lumen-apposing metal stent across the puncture tract. The results showed that fluoroscopy-guided GJ may be a technically feasible and simple procedure but, before clinical trials can be undertaken, further technical refinements are required to reduce the risk of inadvertent transgression of non-target organs. Copyright (C) 2021, Society of Gastrointestinal Intervention.