key: cord-1052471-z552qi8p
authors: Rossi, Gemma; Petrone, Maria Chiara; Vanella, Giuseppe; Archibugi, Livia; Arcidiacono, Paolo Giorgio
title: EUS-guided gastroenterostomy in a COVID-19-infected patient with duodenal stenosing lymphoma (with videos)
date: 2021-04-21
journal: Endosc Ultrasound
DOI: 10.4103/eus-d-20-00255
sha: 17d993eb19430ed247ea07dda8fb87fff4618710
doc_id: 1052471
cord_uid: z552qi8p

nan

EUS-guided gastroenterostomy (GE) was alternative treatment with respect to conventional therapies for oncological gastric outlet obstruction (GOO) during the COVID-19 pandemic in Italy. This is the case of a patient with obstructing duodenal diffuse large B-cell lymphoma (DLBCL) causing GOO. Malignant duodenal stenosis was treated by the wireless EUS-GE simplified technique: in a single step, EUS-GE was performed, directly puncturing with a hot-cautery device the jejunal loop and using a fully-covered lumen-apposing metal stent (LAMS). A pneumatic stent dilation was finally performed to consolidate the newly-created fistula. The patient was able to tolerate oral feeding and discharged 2 days after. An adequate nutritional state persists after 8 months, with patency of the stent.

In the context of the COVID-19 crisis in Italy, EUS-GE was preferred to surgery for GOO with a rapid hospital discharge and prompt oncological treatment resumption.

COVID-19 outbreak dramatically changed patients' management in Italy, especially for oncological patients, due to their higher risk of becoming critically ill contracting the virus. Oncologists have to reassess the surgical procedures need, considering nonsurgical management whenever possible. [1] In this period, a 53-year-old male presented with GOO. Upper-GI endoscopy revealed a large duodenal bulb Forrest 3 ulcer [ Figure 1 ], with second duodenum stenosis [ Figure 2 ], positive for DLBCL. Two cycles of specific chemotherapy were given. Finished second cycle, the patient developed a mild form of COVID-19 disease with pharyngeal swabs positive for 90 days.

Given GOO presence in COVID-19 patient, EUS-GE was considered. The procedure was performed in a negative-pressure endoscopic room under oro-tracheal intubation. Under endoscopic and fluoroscopic control a guide-wire was advanced through the duodenal stenosis to the first jejunal loop; a 7-French pig-tail nasojejunal This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. to distend the first jejunal loop at Treitz ligament. With adequate loop distension and clear lumen evidence, methylene blue dye was injected through the N-JT for subsequent GE patency assessment. EUS-GE was performed in a single step directly puncturing with a hot-cautery device jejunal loop, positioning a fully-covered LAMS (LAMS; HotAxios-Boston Scientific) 2 cm in caliber, 1 cm length, to connect gastric wall with first jejunal loop [ Figure 3 ]. [2] Methylene blue dye outlet was immediately seen; iodinate contrast injection into N-JT confirmed stomach-jejunum connection [Video 1]. Pneumatic stent dilation up to 18 mm was performed [Video 2]. 24 h contrast X-ray confirmed LAMS correct positioning and patency [ Figure 4 ]. Two days after, the patient was able to tolerate oral feeding and was discharged. An adequate nutritional state persists after 8 months, with patency of the stent [ Figures 5, 6 and Video 3]. Being the lymphoma in complete remission, a surgical/more definitive strategy will be discussed.

impacts on life quality and oncological regimens adherence. In the context of the COVID-19 crisis in Italy, EUS-GE was preferred to surgery for GOO with a rapid hospital discharge and prompt oncological treatment resumption.

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Nil.

There are no conflicts of interest.

The COVID-19 pandemic and its impact on the cardio-oncology population

EUS-guided gastroenterostomy: Less is more! The wireless EUS-guided gastroenterostomy simplified technique (WEST)