Gf uct180

A variety of transgastric interventions were performed for suspected luminal and/or extraluminal pathology. The index transgastric intervention was performed either during the same session as EUS-GG creation (i. e., single-session EDGI) or in a subsequent session after EUS-GG creation (i. e., dual-session EDGI). Depending on the indication for EDGI, either a diagnostic gastroscope (GIF-HQ190; Olympus, Central Valley, Pennsylvania, United States), therapeutic gastroscope (GIF-1TH190; Olympus) and/or linear echoendoscope (GF-UCT180; Olympus) was passed through the LAMS, or through a mature GG/JG fistula immediately following LAMS removal, into the bypassed stomach. Fluoroscopy was used to help guide the scope in a parallel fashion through the LAMS to reduce risk of LAMS dislodgment. Transgastric EUS was performed in eight of 14 patients (57.1 %) using a 14.6-mm (outside diameter) therapeutic linear echoendoscope. In four cases, the therapeutic echoendoscope was passed through a mature GG/JG fistula immediately following LAMS removal (all dual-session EDGIs). In three cases, transgastric passage of the therapeutic echoendoscope occurred through an indwelling 20-mm LAMS (all dual-session EDGIs). In one case, transgastric passage of the therapeutic echoendoscope occurred through an indwelling 15-mm LAMS, after LAMS fixation (single-session EDGI).

E-DUS combines endoscopy and duplex ultrasound to obtain detailed images beyond the innermost lining of the digestive tract. The procedure was performed with a Hitachi Aloka ProSound F75 and an Olympus GF-UCT180 curved linear array ultrasonic videoscope (180° ultrasound field of view). All E-DUS examinations were performed by the same experienced endoscopist (KÅ) at the Endoscopy Laboratory of the Department of Gastroenterology, Oslo University Hospital. Standards for E-DUS procedure were followed.22 (link),23 (link) All patients were in at least 6 hours of fasting state before the examination. All procedures were performed under conscious sedation with midazolam (mean 3.35 mg) and alfentanil (mean 0.77 μg). SaO₂ was kept above 95% during the procedure. The patients were carefully monitored for any hemodynamic changes. The videoscope was placed in the upper part of the stomach along the lesser curvature and a longitudinal view of the aorta was obtained to identify the origin of the CA and SMA. None of the patients developed complications related to the endoscopy.

All procedures were performed under general anesthesia. Side-viewing endoscopes (TJF-160 or TJF-180; Olympus America, Melville, NY, USA) were used for the ERCP. The 15-cm double pigtail stents of varying diameters (5 to 10 Fr) were used for stenting the cystic duct (Cook Medical, Winston-Salem, NC, USA). Conventional curvilinear array oblique-viewing therapeutic echoendoscopes were used for EUS-GBD (GF-UCT 180; Olympus America). Fully covered self-expanding metal stents with anti-migratory fins (FCSEMS-AF; Viabil; Conmed, Utica, NY, USA) were placed transluminally. Antibiotics were administered empirically.

The procedures were routinely performed by experienced endoscopists (experience with > 200 EUS examinations
12 (link)
), using a linear EUS scope (GFUCT180, Olympus, Hamburg, Germany). Patients were either under deep sedation or general anesthesia and they all received both infection and pancreatitis prophylaxis (intravenous antibiotic and rectal nonsteroidal anti-inflammatory, respectively), prior to treatment.
EUS-RFA was performed according to the procedure description by Barthet et al
7 (link)
, using a 19-gauge internally cooled electrode needle with 10-mm exposed tip, (EUSRA) and at least one power application of 50 watts was performed, through a VIVA COMBO* RF generator (Taewoong/STARMED, Koyang, Korea-imported in Belgium by Prion medical). The needle was carefully inserted into the target lesion, while maintaining a distance of at least 2 mm from the bilio-pancreatic ducts and vascular structures, after Doppler assessment (
Fig. 1). The procedure was considered complete when echogenic bubbles occurred (“steam popping”), meaning that the tissue impedance had increased to more than 100 Ohms (
Fig. 2). As there still is no standard protocol for procedure duration, ablation time was not predetermined and varied between patients.