Sand dollar sign

Law, Ryan; Pérez-Miranda, Manuel; Baron, Todd H.

doi:10.1016/j.gie.2020.08.033

Cited by 1 publication

(1 citation statement)

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“…More recently, EDGE has been developed, connecting the gastric pouch and the excluded stomach to restore the access to the papilla by a standard duodenoscope [ 75 ], potentially overcoming the invasiveness of LA-ERCP and the technical limitations of EA-ERCP [ 15 , 74 ]. From the gastric pouch, the excluded stomach is identified under EUS guidance using the “sand dollar” sign [ 76 ], punctured using a 19-G needle and then filled with saline. An ec-LAMS is then released between the excluded stomach and the gastric pouch, creating a gastro-gastrostomy [ 77 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage and gastrointestinal anastomoses: the journey from promising innovations to standard of care

Vanella

Dell’Anna

Bronswijk

et al. 2022

aog

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Biliary obstruction (BO) and gastric outlet obstruction (GOO) are frequent complications of pancreatobiliary and gastroduodenal neoplasia, which can severely impact oncological outcomes, patient survival and quality of life. Although endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for biliary drainage, this may fail or be unfeasible because of duodenal/papillary infiltration or surgically-altered anatomy. Percutaneous transhepatic biliary drainage (PTBD) has been the standard rescue therapy in this setting, but is burdened by high morbidity and reduced quality of life. As for GOO, surgical gastroenterostomy and enteral stenting are limited by invasiveness and suboptimal long-term outcomes, respectively. Endoscopic ultrasound (EUS) has evolved from a diagnostic to a therapeutic modality, providing a safe and effective alternative for draining the pancreatobiliary tract into the stomach or duodenum. EUS-guided biliary drainage (EUS-BD) has already demonstrated similar efficacy, greater safety and fewer reinterventions compared to PTBD, and can be performed in the same session after ERCP failure. Further development of lumen apposing metal stents has paved the way towards the creation of EUS-guided anastomoses. EUS-guided gastroenterostomy (EUS-GE) is nowadays increasingly used to treat GOO, combining the minimal invasiveness of endoscopy with surgical-range efficacy. This review summarizes the technical details, current evidence and society recommendations contributing to EUS-BD and EUS-GE gaining ground in everyday practice or tertiary referral centers and becoming crucial in improving the multidisciplinary management of cancer-related symptoms.

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