Endoscopic ultrasound-guided gastroenterostomy: The new standard treatment of gastric outlet obstruction

Figure 1 Endoscopic ultrasound-guided gastroenterostomy in afferent loop syndrome. А: Echoendoscopic view demonstrating the afferent loop; В: Fluoroscopic view confirming the positioning and deployment of the stent.

Figure 2 Step-by-step visualization of endoscopic ultrasound-guided gastroenterostomy procedure. A: Fluoroscopic view showing a 7Fr nasobiliary catheter placed into the jejunum over a guidewire; B: Echoendoscopic view displaying the duodenum and jejunum distended with contrast material and methylene blue before direct puncture; C: Real-time puncture of the stomach and jejunal wall using the freehand technique under endoscopic ultrasound guidance; D: Fluoroscopic confirmation of successful stent deployment; E: Endoscopic confirmation ensuring correct positioning and lumen patency of the deployed stent.

Figure 3 Type I stent misdeployment. A: Fluoroscopic view showing the distal flange of the lumen-apposing metal stent deployed in the peritoneal cavity while the proximal flange remains in the stomach; B: Endoscopic view confirming the incomplete anastomosis with the small bowel intact.

Figure 4 Type II stent misdeployment. A: Fluoroscopic view demonstrating the distal flange of the lumen-apposing metallic stents deployed in the peritoneum with evidence of an enterotomy; B: Endoscopic view revealing the perforation at the small bowel site, requiring further intervention.