"Through-stent enterography": first experience with a novel technique intended to improve safety in endosonography-guided gastroenterostomy.

Background and Aims: Endosonography-guided gastroenterostomy (EUS-GE) is a novel technique to manage symptoms of gastric outlet obstruction. Major challenges are the high mobility of intestinal loops and the transient loss of endosonographic visibility during the puncture. This can lead to stent misdeployment, which can be associated with potentially fatal adverse events. By injecting contrast medium through the guidewire channel of the lumen-apposing metal stent application system under fluoroscopic guidance, a positive enterogram can confirm the position of the stent inside the intestinal lumen before its deployment. The aim of this study was to describe this novel technique and to assess its feasibility. Methods: The data of 39 consecutive patients undergoing EUS-GE with "through-stent-enterography" from July 2020 to March 2022 were retrospectively collected and analyzed. The primary end point was technical success. Secondary end points were adverse events, reinterventions, and clinical success. Results: Technical success was achieved in all cases (n = 39). In 2 cases, a second puncture was required to place the stent successfully. In 1 case, misdeployment could be avoided after a negative enterogram. In the other case, misdeployment occurred despite a positive enterogram and reintervention was needed. Clinical success was achieved in 92.3% (n = 36). No major adverse events or mortalities were encountered. Conclusions: "Through-stent enterography" after the puncture to confirm the correct position of the stent in the small bowel is a novel and simple technique that can potentially reduce the risk of misdeployment of the stent.