Duodenal endoscopic submucosal dissection and sutured defect closure across a lumen-apposing metal stent Phillip S. Ge, MD, Hiroyuki Aihara, MD, PhD,

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Duodenal endoscopic submucosal dissection and sutured defect closure across a lumen-apposing metal stent Phillip S. Ge, MD, Hiroyuki Aihara, MD, PhD, Christopher C. Thompson, MD, MHES, Marvin Ryou, MD VideoGIE DOI: 10.1016/j.vgie.2018.08.001 Copyright © 2018 Terms and Conditions

Figure 1 Creation and reversal of gastric access temporary for endoscopy (GATE). A, EUS-guided puncture of the remnant stomach from Roux limb. B, Injection of contrast material into the remnant stomach. C, Creation of jejunogastric GATE with deployment of lumen-apposing metal stent (LAMS). D, Removal of LAMS after successful trans-GATE endoscopic procedure. E, Prior access site 2 weeks after GATE reversal. F, Injection of contrast material showing no persistent jejunogastric fistula. VideoGIE DOI: (10.1016/j.vgie.2018.08.001) Copyright © 2018 Terms and Conditions

Figure 2 Transgastric access temporary for endoscopy (GATE) endoscopic submucosal dissection (ESD) and sutured defect closure. A, Lumen-apposing metal stent 2 weeks after GATE creation. B, Large polyp in the duodenal bulb. C, ESD of the duodenal bulb. D, Resection defect after successful duodenal ESD. E, Sutured closure of the resection defect. F, Injection of contrast material showing no extravasation after sutured defect closure. VideoGIE DOI: (10.1016/j.vgie.2018.08.001) Copyright © 2018 Terms and Conditions