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

Figure 3 A 62-year-old female with metastatic colon cancer presented with distal small bowel obstruction secondary to peritoneal adhesions. Endoscopic ultrasound-guided enterocolostomy was performed for palliative decompression. A: Contrast-enhanced computed tomography demonstrated diffuse small bowel dilation consistent with distal obstruction; B: Endosonographic visualization of the dilated small bowel loop from the descending colon; C: The target small bowel was accessed using a 19-gauge needle and further distended under endoscopic ultrasound guidance with a mixture of contrast and water; D: A 15-mm lumen-apposing metal stent (LAMS) was deployed to create an enterocolonic fistula; E: Endoscopic view confirming appropriate stent expansion and positioning; F: A double-pigtail plastic stent was placed through the LAMS to maintain patency and reduce the risk of stent occlusion or migration.