Fig. 3. A 66-year-old female with metastatic cholangiocarcinoma and gastric outlet obstruction undergoing endoscopic ultrasound (EUS)-guided gastrojejunostomy. (A) Tumor ingrowth into two previously placed duodenal stents. (B) EUS visualization of a 20 mm balloon inflated in the proximal jejunum (large arrow) followed by a 19-gauge needle puncture (small arrow). (C, D) Balloon dilation (arrow) of the gastrojejunal fistula over a 0.035 inch guidewire. Endoscopic (E) and fluoroscopic (F) demonstration of contrast flow across 10 × 15 mm lumen-apposing stent (arrow) into the jejunum (images courtesy of Shayan Irani, MD, Virginia Mason Medical Center).
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