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Endosc Int Open. 2017 Sep;5(9):E893-E899. doi: 10.1055/s-0043-115386. Epub 2017 Sep 13.

Double endoscopic bypass for gastric outlet obstruction and biliary obstruction.

Author information

1
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
2
Borland-Groover Clinic, Jacksonville, Florida, United States.
3
Division of Gastroenterology and Hepatology, Virginia Mason Hospital, Seattle, Washington, United States.
4
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States.

Abstract

BACKGROUND AND STUDY AIMS:

 Double endoscopic bypass entails EUS-guided gastroenterostomy (EUS-GE) and EUS-guided biliary drainage (EUS-BD) in patients who present with gastric outlet and biliary obstruction. We report a multicenter experience with double endoscopic bypass.

PATIENTS AND METHODS:

 Retrospective, multicenter series involving 3 US centers. Patients who underwent double endoscopic bypass for malignant gastric and biliary obstruction from 1/2015 to 12/2016 were included. Primary outcome was clinical success defined as tolerance of oral intake and resolution of cholestasis. Secondary outcomes included technical success, re-interventions and adverse events (AE).

RESULTS:

 Seven patients with pancreatic head cancer (57.1 % females; mean age 64.6 ± 12.5 years) underwent double endoscopic bypass. Four patients had EUS-GE and EUS-BD performed during the same session with a mean procedure time of 70 ± 20.4 minutes. EUS-GE and EUS-BD were technically successful in all patients, all of whom were able to tolerate oral intake with resolution of cholestasis in 6 (87.5 %). One patient had a repeat EUS-BD with normalization of bilirubin. There were no adverse events.

CONCLUSIONS:

 Double endoscopic bypass is feasible and effective when performed by experienced operators. Studies comparing this novel concept to existing techniques are warranted.

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