Double EUS bypass: same sequence, different reasons

摘要

In December, the video case report by Kevin D. Platt et al 1 was published online, describing the successful EUS-guided palliation of a metastatic ovarian cancer with biliary and duodenal obstruction. We agree with the au- thors that simultaneous creation of a double EUS bypass is feasible, and we think that this is a crucial addition to the endoscopic armamentarium in patients with a bifocal stenosis. 2,3 In the current case report, the authors mention performing the EUS-guided gastrojejunostomy (EUS-GJ) first, followed by the EUS-guided hepaticogas- trostomy. In our opinion, aside from preventing EUS- guided hepaticogastrostomy dislodgement after EUS-GJ, there are 2 other important reasons to perform these pro- cedures in the described order.