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EUS-guided liver biopsy using a novel hydrostatic stylet technique.

ABSTRACT: Video 1Hydrostatic stylet technique for the performance of EUS-guided liver biopsy.

SUBMITTER: Magahis PT

PROVIDER: S-EPMC10020006 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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EUS-guided liver biopsy using a novel hydrostatic stylet technique.

Magahis Patrick T PT Westerveld Donevan D Simons Malorie M Hissong Erika E Carr-Locke David L DL Sampath Kartik K Sharaiha Reem Z RZ Mahadev SriHari S

VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20230119 3

Video 1Hydrostatic stylet technique for the performance of EUS-guided liver biopsy. ...[more]

PMID: 36935805

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Project description:Background and aimsEUS-guided gastroenterostomy (EUS-GE) is effective in relieving gastric outlet obstruction. Several techniques used to create EUS-GEs have been described. However, these techniques are dependent on passing a guidewire beyond the obstruction. We describe a direct needle-puncture technique that allows for successful EUS-GE creation without a guidewire.MethodsThe direct antegrade EUS-GE method often involves passing a guidewire and tube beyond the obstruction to distend the small bowel. An oblique echoendoscope is then positioned in the stomach to locate the distended small bowel. An electrocautery-enhanced lumen-apposing metal stent (LAMS) is used to create the anastomosis. However, in cases when neither endoscope nor guidewire can be passed across the obstruction, the direct needle-puncture technique can be used. With the oblique echoendoscope positioned in the stomach, a collapsed loop of small bowel is located adjacent to the gastric wall. A 19-gauge needle is used to puncture the gastric and small bowel wall. The small bowel is distended with a mixture of saline, methylene blue, and contrast via a standard water pump connected to the needle. An antispasmodic is administered, and an electrocautery-enhanced LAMS is then introduced into the working channel to create a gastroenterostomy using the freehand method.ResultsThe direct needle-puncture technique was performed in 4 patients for these indications: postsurgical inflammation causing gastric outlet obstruction (case 1), tumor infiltration causing gastric outlet obstruction (cases 2A and 2B), and pancreaticobiliary limb access in a duodenal switch (case 3). The video shows the technique performed in a patient with postsurgical inflammation and a patient with duodenal tumor infiltration.ConclusionsThe direct needle-puncture technique is useful for performing gastroenterostomy when the guidewire cannot be passed beyond the obstruction. It can also be used to gain access to a targeted bowel limb in altered anatomy for diagnostic and therapeutic purposes.

Dataset Information

EUS-guided liver biopsy using a novel hydrostatic stylet technique.

Publications

EUS-guided liver biopsy using a novel hydrostatic stylet technique.

Similar Datasets

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