Echoendoscopic gastrojejunostomy is one of the ways we have to create a bypass for severe duodenal stenosis secondary to a pancreatic tumor.

Other options are the TTS duodenal stents, which is often quite complex to position and dysfunctions in the duodenum very easily, or a laparoscopic gastrojejunostomy.

These last two approximations have been compared several times, as in:

• Endoscopic ultrasound-guided gastroenterostomy for the management of gastric outlet obstruction: A large comparative study with long-term follow-up
• Clin Gastroenterol. 2017 Nov/Dec;51(10):896-899. doi: 10.1097/MCG.0000000000000887

Existing similar rates of clinical and technical success in both approaches but with fewer side effects and less stay and cost for the endoscopic option.

We present this case of Gastro-Jeyunostomy by echoendoscopy, using the EG-UC5T linear sonoscape equipment, in which we will review the basic steps of the technique:

1. Pass of the 0.035 guide wire with the help in this case of a sphincterotome for the severe angle.
2. Passage of a 7 Fr naso-biliary catheter beyond the treinta angle.
3. Instillation of methylene blue labeled water to obtain a good target for the stent deployment.
4. Placement of a 15mm Hot-Axios stent creating the anastomosis
5. endoscopic verification of normal stent positioning