Buttar, Navtej

Abstract Background and Aims EUS-guided gastroenterostomy (EUS-GE) is an effective option to palliate symptoms of gastric outlet obstruction (GOO). While the jejunum is conventionally targeted (EUS-GJ), targeting the duodenum (EUS-GD) may offer clinical advantages. Outcomes were compared for EUS-GJ and EUS-GD. Methods Adult patients who underwent EUS-GE for GOO between 2020 and 2024 were included and categorized as an EUS-GD if the stent entered the transverse or ascending duodenum or an EUS-GJ if the stent entered more distally. The primary outcome was clinical success (soft diet tolerance at 7 days). Secondary outcomes included adverse events (AEs), stent misdeployment, and unplanned endoscopic reintervention. Baseline demographic variables and outcomes were compared with statistical significance at p < 0.05. Results Of the 139 included patients (median age 67 years (IQR 61–74); 41% female), 105 underwent EUS-GJ and 34 underwent EUS-GD. Clinical success was 98% for EUS-GJ and 94% for EUS-GD (p = 0.25). The misdeployment rate was 7% for EUS-GJ and 0% for EUS-GD (p = 0.19). The AE rate was 22% for EUS-GJ and 12% for EUS-GD (p = 0.23). There were no significant differences for stent obstruction (EUS-GJ 12% vs. EUS-GD 6%), bleeding (2% vs. 6%), perforation (4% vs. 0%), stent migration (1% vs. 0%), infection (3% vs. 0%), and unplanned reintervention (14% vs. 9%). Conclusion Both EUS-GJ and EUS-GD demonstrate high clinical success with no significant differences in adverse event rates. These data can support intraprocedural decision-making for endoscopists performing EUS-GE.

Objectives On rare occasions, hiccups can cause morbidity, such as sleep deprivation, aspiration and even death. At times, palliative invasive procedures are considered. This study tested the hypothesis that invasive procedures can provide hiccup palliation with an acceptable safety profile. Methods Multi-site electronic medical data were used to assess adult patients who underwent an invasive procedure for hiccups between January 1995 and January 2022. Hiccup palliation was defined as documented improvement in severity or frequency of this sign/symptom after the procedure. Results A total of 69 patients underwent one or more invasive procedures for hiccups (144 total procedures). Fifty-nine patients (86%) were men. The most frequent initial procedure was a phrenic nerve block (n=10) followed by oesophageal dilation (n=9). Only 31 patients (45%) manifested hiccup palliation after their first procedure. Nearly half, or 32 patients (46%), underwent more than one procedure (2 underwent nine procedures). Of these subsequent procedures, 35 resulted in palliation. Five adverse events arose from 144 procedures: post-esophagectomy atrial fibrillation, haematoma after cardiac device removal, vocal cord immobility after craniotomy, vocal cord immobility after vagal nerve manipulation, and a cerebral spinal leak after vagal nerve decompression. Conclusions Invasive procedures can palliate hiccups with an acceptable safety profile. However, these procedures appear to palliate hiccups in only about half of patients and sometimes do so only transiently.

ABSTRACT Objectives Patients requiring long‐term enteral nutrition or continuous infusion of carbidopa/levodopa can benefit from jejunostomy tube placement. Recently, directly placed percutaneous transgastric jejunal tubes (TGJs) have been used instead of gastrostomy tubes with jejunal extensions (PEG‐Js) for enteral access. We aim to compare patient characteristics and outcomes after placement of TGJs placed via the introducer technique compared to PEG‐Js. Methods We performed a retrospective study of 141 patients (TGJ = 58, PEG‐J = 83) assessed at Mayo Clinic between 2010 and 2024. Patients were identified using a prospectively maintained procedure data registry. Demographic data, patient characteristics, procedural indications, complications, and first‐replacement date were gathered. Statistical analysis included the Wilcoxon rank sum test, chi‐square test, Fisher's exact test, and Kaplan‐Meier estimates. Patients receiving carbidopa/levodopa were excluded from complications analysis due to the carbidopa/levodopa tube's proprietary structure. A p ‐value of <0.05 was set as a threshold for significance. Results Our results demonstrated no difference in cumulative incidence of complications within 1 year for TGJs and PEG‐Js, p ‐value 0.48. Regarding time to first replacement, treating death as a competing risk factor, there was no statistically significant difference in cumulative incidence of replacement within 1 year for TGJs and PEG‐Js, p ‐value 0.389. Conclusions Our study demonstrates that both direct TGJs and PEG‐Js are safe options for long‐term jejunal feeding. More studies are needed to compare endoscopic to radiologically placed percutaneous transgastric jejunal feeding tubes.

ABSTRACT Anastomotic leaks following complex gastrointestinal surgeries pose a significant challenge, especially in patients unfit for further surgical intervention. We present a novel 3-staged endoscopic approach to restore gut continuity in a 55-year-old woman with multiple anastomotic leaks and discontinuous bowel segments following extensive abdominal surgeries. The procedure included stent placement, endoscopic ultrasound (EUS)-guided gastrojejunostomy with a lumen-apposing metal stent (LAMS), and fistula plug insertion with glue. Over 6 months, bowel continuity was restored, and at 6-year follow-up, the patient remains symptom free, tolerating oral intake. This case demonstrates the transformative potential of advanced endoscopic techniques in managing complex gastrointestinal disruptions without further surgery.