Endoscopic ultrasound-guided colocolostomy for malignant transverse colon obstruction after failure of enteral stenting

 

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Developments in therapeutic endoscopic ultrasound (EUS) have allowed the endoscopic creation of gastrointestinal anastomoses for gastric outlet obstruction [1] [2]. However, this approach is rarely performed for the lower gastrointestinal tract because of the technical challenge of EUS-guided colocolostomy. Herein, we describe EUS-guided colocolostomy in a patient with malignant obstruction affecting a long segment of the transverse colon after failure of enteral stenting.

A 54-year-old woman with metastatic gastric cancer developed vomiting and abdominal distension 12 months after a Billroth II gastrectomy. Abdominal computed tomography demonstrated a long segment of stenosis affecting the transverse colon near the hepatic flexure with luminal dilatation and effusion in the ascending colon proximal to the lesion ([Fig. 1]). Colonoscopy revealed severe stricturing of the transverse colon ([Fig. 2 a]). A guidewire was passed through the stricture; however, colonic enteral stenting was unsuccessful. A nasobiliary catheter was placed across the stricture and a linear echoendoscope (GF-UCT260; Olympus, Tokyo, Japan) was advanced into the descending–sigmoid colon flexure. Saline solution was instilled to facilitate puncture under EUS guidance from the descending–sigmoid junction ([Fig. 2 b]). The dilated lumen was punctured with a 19-gauge FNA needle followed by a 5-Fr cystoenterostomy needle knife (Cook Medical, Indiana, USA), which provided sufficient force to create a bypass across the long obstructing segment ([Video 1]). A 16 × 15-mm electrocautery lumen-apposing metal stent (Axios-EC, Boston Scientific, USA) was then advanced into the hepatic flexure to form a colocolostomy ([Fig. 2 c, d]). Gastrointestinal radiography with contrast after the procedure demonstrated an unobstructed enteroenteral bypass. The patient was provided a liquid diet from postoperative day 1 and reported multiple subsequent bowel movements. A semiliquid diet was maintained until follow-up at 4 months after the procedure.

Video 1 Endoscopic ultrasound (EUS)-guided colocolostomy for malignant obstruction affecting a long segment of the transverse colon, after failure of enteral stenting.

EUS-guided colocolostomy represents a novel endoscopic method of managing colonic obstruction. This approach allows aggressive endoscopic interventions in patients where colonic enteral stenting has failed.

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Publication History

Article published online:
09 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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