Endoscopic ultrasound-guided ileocolonic anastomosis for relief malignant bowel obstruction

A 71-year-old patient was referred for 13-year recurrent cough/expectoration, 10-year post-exertional dyspnea, and 1-day worsening abdominal pain/distension. He had recurrent acute exacerbations of chronic obstructive pulmonary disease , left lung squamous cell carcinoma (Stage IB), and coronary heart disease. Computed tomography (CT) showed a distal ileal mass (≈5th group), luminal narrowing, and proximal small bowel obstruction ( Fig. 1 ). Surgery was suggested but declined by the family due to poor pulmonary function and high risk. Endoscopic ultrasound-guided ileocolonic anastomosis (EUS-ICA) under general anesthesia was performed after multidisciplinary discussion ( Video 1 ).

Fig. 1.

a Preoperative axial CT: distal ileal mass (fifth group,) with luminal narrowing and proximal small bowel obstruction. b Preoperative coronal CT: distal ileal mass (fifth group,) with luminal narrowing and proximal small bowel obstruction. CT, computed tomography.

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Detailed operation of EUS-guided ileocolonic anastomosis combined with LAMS placement for MBO. MBO, Malignant bowel obstruction.

Video 1

Postoperatively, the patient passed stool the same day; follow-up CT showed improved small bowel dilatation ( Fig. 2 ). On postoperative day 2, stent balloon dilation ( Fig. 3 ) relieved abdominal distension and restored defecation/flatulence. He was transitioned to oral nutrition, discharged on day 4, and remained well on follow-up.

Fig. 2.

a Postoperative axial CT revealed intestinal dilatation, with the stent in place. b Postoperative coronal CT revealed intestinal dilatation, with the stent in place. CT, computed tomography.

Fig. 3.

a Post-EUS-ICA imaging showing the patent anastomosis site. b Intraendoscopic fluoroscopy of anastomotic stoma balloon dilatation.

Malignant bowel obstruction (MBO) is a common complication in patients with advanced cancer, occurring in 10–28% of those with gastrointestinal malignancies. MBO can lead to dehydration, electrolyte imbalances, sepsis, intestinal perforation, and other serious complications that profoundly impair quality of life; the median survival ranges from 1 to 9 months. EUS-guided ileocolonic anastomosis is a safe and effective minimally invasive approach for palliation of MBO in high-risk patients with advanced cancer and severe comorbidities. It enables the rapid resolution of obstructive symptoms, restoration of bowel functions, and improvement in the quality of life, making it a valuable addition to the therapeutic armamentarium for MBO when surgical intervention is not feasible.

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