[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-459156-105":59,"doc-detail-459156-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","cholangioscopy-and-double-guidewires-facilitate-a-difficult-endoscopic-ultrasound-guided-gastroenterostomy-case-report","Cholangioscopy and double guidewires facilitate a difficult endoscopic ultrasound-guided gastroenterostomy - Case report","","Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using electrocautery-enhanced lumen-apposing metal stents (LAMSs) offers a minimally invasive option for gastric outlet obstruction, but failed guidewire passage can hinder the procedure. In a 59-year-old woman with surgically altered anatomy after liver transplantation and hilar bile duct plasty, severe scope looping prevented reaching the pylorus. Cholangioscopy via a colonoscope, angled-tip guidewires, and dual-guidewire access enabled real-time identification and safe LAMS deployment with reduced fluoroscopy reliance.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cholangioscopy-and-double-guidewires-facilitate-a-difficult-endoscopic-ultrasound-guided-gastroenterostomy-case-report/459156/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cholangioscopy-and-double-guidewires-facilitate-a-difficult-endoscopic-ultrasound-guided-gastroenterostomy-case-report/459156.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was EUS-GE difficult in this case?","Question",{"text":112,"@type":113},"Severe scope looping and multiple unsuccessful endoscopes prevented passage to the pylorus in a patient with surgically altered anatomy.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did cholangioscopy through a colonoscope help?",{"text":117,"@type":113},"A 9Fr cholangioscope advanced through the colonoscope channel traversed the pylorus and entered the duodenal bulb, revealing a hidden pathway to the jejunum.",{"name":119,"@type":110,"acceptedAnswer":120},"What role did dual-guidewire access play?",{"text":121,"@type":113},"Using guidewire-assisted access provided a procedural backup for feeding tube placement and allowed repeat cholangioscopy to confirm LAMS deployment, reducing reliance on fluoroscopy.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},459156,1790755296,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":24,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Article published online: 2026-01-08  \nCholangioscopy and double guidewires facilitate a difficult endoscopic ultrasound-guided gastroenterostomy  \nEndoscopic ultrasound-guided gastroenterostomy (EUS-GE) with electrocauteryenhanced lumen-apposing metal stents (LAMSs) is a promising minimally invasive approach for benign or malignant gastric outlet obstruction (GOO) . Guidewireassisted oroenteric catheters (OECs) or balloon catheters are commonly used to distend the small bowel for puncture. However, failed guidewire passage may complicate the procedure.  \nA59-year-old woman with GOO after liver transplantation and hilar bile duct plasty was scheduled for EUS-GE. However, multiple endoscopes (ultra-slim endoscope, enteroscope, gastroscope, and colonoscope) failed to reach the pylorus due to severe scope looping, despite abdominal compression and repositioning ( ▶ Fig.1a) . To overcome this situation, a 9Fr cholangioscope (IMAX, Nanwei Medical) was advanced through the 3.7mm channel of a colonoscope, traversed the pylorus, and entered the duodenal bulb ( ▶ Fig.1b) . The pathway was visualized hidden at a 1 o ’clock position in the duodenal bulb ( ▶ Fig.2) . Under direct vision, an angled-tip hydrophilic guidewire (RF*PA35263M, Terumo) was advanced, followed by the cholangioscope into the jejunum ( ▶ Fig.3). Subsequently, a Boston Scientific Jagwire high-performance guidewire (M00556580) was inserted via an 8.5Fr bougie catheter to secure dual-wire access ( ▶ Fig.4) . Then, a 7Fr OEC was used to infuse dye-mixed saline. Finally, a 15-mm Hot AXIOS LAMS (Boston Scientific) was successfully deployed under a linear echoendoscope guidance, with positioning confirmed by endoscopy, EUS, and fluoroscopy ( ▶ Fig.5 ,▶Video 1) . The second guidewire was then withdrawn. The patient resumed a liquid diet 3 days later.  \nThis case highlights key technical advantages that enabled successful EUS-GE in surgically altered anatomy. First, cholangioscopy within a colonoscope increased  \na  \nb  \n▶Fig.1 a Schematic illustration showing severe scope looping in a patient with gastric outlet obstruction and surgically altered anatomy after liver transplantation and hilar bile duct plasty, preventing endoscopic passage to the pylorus despite abdominal compression and repositioning. b Schematic illustration of a cholangioscope advanced through the working channel of a colonoscope to traverse the pylorus and enter the duodenal bulb, overcoming the limitation of severe scope looping in surgically altered anatomy.  \nrigidity and reach, overcoming severe gastric looping. Second, angled-tip guidewires enabled precise navigation under direct vision by cholangioscopy. Third, real-time visualization allowed the  \n▶Fig.2 The hidden pathway to the jejunum located at the 1 o ’clock position in the duodenal bulb, obscured by altered gastric anatomy.  \n▶Fig.3 An angled-tip hydrophilic guidewire was inserted, navigating a sharply curved duodenal bulb with the maximal bend highlighted by a red circle, and advancing distally into the jejunum.  \nconfident identification of the jejunal lumen without contrast or radiation. Finally, dual-guidewire access offered a backup for feeding tube placement and enabled repeat cholangioscopy to confirm LAMS deployment, reducing reliance on fluoroscopy.  \nEndoscopy_UCTN_Code_TTT_ 1AO_ 2AN  \nE32 Liu Jiahuan et al. Cholangioscopy and double… Endoscopy 2026; 58: E32–E33 | © 2026. The Author(s) .  \n▶Fig.4 A fluoroscopic image showing dual-guidewire access established using an 8.5Fr bougie catheter.  \nVideo 1 Cholangioscopy-assisted EUS-GE in a patient with surgically altered anatomy. The video highlights overcoming severe scope looping by cholangioscopy through a colonoscope, precise navigation using angled-tip guidewires under direct vision, establishment of dual-guidewire access for the procedural backup, and safe deployment of a LAMS with real-time confirmation, minimizing fluoroscopy use.  \nContributors ʼ Statement  \n\n| Jiahuan Liu: Data","cbCaibjRD82DVxso","https://ap.wps.com/l/cbCaibjRD82DVxso","pdf",2433350,"English","# Case presentation\n## Procedure steps and guidance\n## Outcomes and clinical follow-up","[{\"question\":\"Why was EUS-GE difficult in this case?\",\"answer\":\"Severe scope looping and multiple unsuccessful endoscopes prevented passage to the pylorus in a patient with surgically altered anatomy.\"},{\"question\":\"How did cholangioscopy through a colonoscope help?\",\"answer\":\"A 9Fr cholangioscope advanced through the colonoscope channel traversed the pylorus and entered the duodenal bulb, revealing a hidden pathway to the jejunum.\"},{\"question\":\"What role did dual-guidewire access play?\",\"answer\":\"Using guidewire-assisted access provided a procedural backup for feeding tube placement and allowed repeat cholangioscopy to confirm LAMS deployment, reducing reliance on fluoroscopy.\"}]","Cholangioscopy and double guidewires facilitate a difficult endoscopic ultrasound-guided gastroenterostomy - Case report | PDF"]