Modified EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS): a pilot study.

Introduction We recently developed a double balloon device (DBD), using widely available existing technology, to facilitate EUS-gastroenterostomy. Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS). Methods Single-centre, retrospective study of consecutive patients undergoing M-EPASS from January 2019-August 2020. The DBD consists of two vascular balloons that optimizes the distention of a targeted small bowel segment for EUS-guided stent insertion. The primary endpoint is the rate of technical success. Results A total of 11 patients with malignant gastric outlet obstruction were included: mean age 64.98.6 with 45% of female gender. Technical and clinical success (ability to tolerate an oral diet) were 91% (10/11) and 80% (8/10), respectively. There was one adverse event (9%) due to stent migration. Two patients (18%) required re-intervention for stent obstruction secondary to food impaction. The mean time to a low residue diet was 3.5 days2.4. Conclusion M-EPASS appears to facilitate the technique of EUS-GE potentially enhancing its safety and clinical adoption. Larger studies are needed to validate this innovative approach to gastric outlet obstruction