A novel technique for enhancing EUS-guided gastrojejunostomy: the dual-scope method.

Background and Aims: EUS-guided gastrojejunostomy (GJ) is an emerging alternative to surgical bypass or enteral stenting in malignant gastric outlet obstruction. The conventional nasobiliary technique poses challenges such as scope exchange and loss of target bowel distension. We describe a novel "dual-scope" technique using an ultraslim gastroscope for direct bowel infusion during EUS-GJ. Methods: Thirteen consecutive patients underwent EUS-GJ using the dual-scope technique between June 2020 and April 2024. An ultraslim endoscope was advanced beyond the obstruction to instill fluid continuously, while the echoendoscope was introduced alongside it to perform EUS-guided lumen-apposing metal stent placement. Outcomes included technical success, procedural feasibility, and adverse events. Results: Patients had a mean age of 63.8 years (range, 38-83 years), and 30% were female. Twelve of 13 cases (92%) were caused by malignant gastric outlet obstruction. Technical success was 100%. No patients required esophageal dilation or experienced trauma from dual-scope passage. One patient developed pneumoperitoneum postprocedure, which was managed conservatively. Conclusions: The dual-scope technique is a safe and effective alternative to nasobiliary-assisted EUS-GJ. It enables continuous, controlled bowel distension without the need for scope exchange and may simplify the procedure, particularly in technically challenging cases.