Endoscopic ultrasound-guided gastrointestinal anastomosis: Evolving applications in advanced therapeutic endoscopy

Figure 1 A 72-year-old female with locally advanced pancreatic adenocarcinoma presented with symptomatic gastric outlet obstruction and underwent endoscopic ultrasound-guided gastroenterostomy for palliation. A: Upper endoscopy demonstrated a severe, malignant-appearing stricture involving the distal duodenal bulb; B: A nasojejunal tube was advanced into the distal duodenum over a guidewire under fluoroscopic guidance; C: A mixture of contrast and water was infused through the nasojejunal tube to distend the small bowel; D: A distended jejunal loop was identified endosonographically from the stomach; E: A 20-mm lumen-apposing metal stent was deployed to create the gastroenterostomy; F: Endoscopic view confirming adequate deployment of the proximal flange within the gastric lumen.