Feasibility of therapeutic endoscopic ultrasound in the bridge-to-surgery scenario: The example of pancreatic adenocarcinoma

Figure 4 Pancreaticoduodenectomy following endoscopic ultrasound-guided double bypass. A: The endoscopic ultrasound-guided gastrojejunostomy site is easily identified and a stable gastrojejunal anastomosis is visible (underlined by blue curves) between the stomach and the small bowel (SB); B-C: The endoscopic ultrasound-guided gastrojejunostomy site is opened with diathermic coagulation, the lumen apposing metal stent is removed (B), and the anastomosis cut (C); D: The SB is prepared for gastroenteric anastomosis, while the gastric defect will be closed using staplers. A classic pylorus-preserving pancreaticoduodenectomy is achievable.