Opinion Review
Copyright ©The Author(s) 2021.
World J Gastrointest Surg. Jul 27, 2021; 13(7): 620-632
Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.620
Figure 2
Figure 2 Endoscopic ultrasound-guided gastrojejunostomy using the nasobiliary drain assisted technique. A: Endoscopic view of the severe luminal obstruction in the proximal duodenum secondary to advanced pancreatic cancer; B: A percutaneous transhepatic biliary drain previously placed for jaundice can be identified on fluoroscopy. A therapeutic endoscope was used to advance and coil a 0.035” guidewire across the obstruction in the distal unobstructed bowel under fluoroscopic guidance; C: A nasobiliary catheter drain was then advanced through the channel of the scope over the guidewire across the obstruction. Contrast was injected under fluoroscopy to identify the target jejunal loop for endoscopic ultrasound (EUS)-guided gastrojejunostomy using; D: The target loop is distended with continuous infusion of fluid via the nasobiliary drain assisting with visualization under EUS; E: Successful EUS puncture of the target loop under EUS for lumen-apposing metal stent (LAMS) placement; F: Fluoroscopic image of the LAMS with adequate apposition of the gastric and jejunal lumen; G: Endoscopic view of the LAMS with confirmation of position by the visualization of the blue dyed water (methylene blue) infused through the nasobiliary drain.