Risk of Small Intestinal Failure from EUS-Guided Jejuno-Sigmoidostomy
Small intestinal failure is not a recognized complication of EUS-guided jejuno-sigmoidostomy, as this procedure creates a bypass between the jejunum and sigmoid colon without resecting or removing any small bowel length. The procedure preserves the entire small intestinal length and therefore does not create the anatomical conditions necessary for short bowel syndrome or intestinal failure 1.
Understanding the Procedure and Its Implications
EUS-guided jejuno-sigmoidostomy creates a fistulous tract between the jejunum and sigmoid colon using endoscopic ultrasound guidance, typically with deployment of a lumen-apposing metal stent (LAMS). This is fundamentally different from surgical resection procedures 2, 3.
Key Distinctions from Resection Procedures
- The procedure does not involve removal of any bowel segments, which is the primary cause of intestinal failure 1
- Small bowel syndrome develops when effective bowel length is shortened through resection, not through creation of bypass tracts 1
- Intestinal failure severity depends on: resection length, resection location, function of bowel remnant, adaptive capabilities, and underlying disease—none of which apply to bypass procedures 1
Actual Complications to Monitor
The documented adverse events from EUS-guided gastroenterostomy procedures (the most closely related and well-studied procedure) include stent misdeployment (most common), bleeding, pneumoperitoneum, peritonitis, and pain, with overall adverse event rates of approximately 12-18%. 2, 4, 5
Specific Safety Concerns
- Peritonitis and sepsis are particularly concerning in patients with ascites, with 16.6% of patients with ascites developing clinical peritonitis or sepsis post-procedure 6
- Stent misdeployment occurs in approximately 12% of cases and represents the most common technical complication 2
- Recurrent obstruction rates are lower with EUS-guided approaches compared to enteral stenting alone 5, 7
Comparative Safety Profile
- EUS-guided gastroenterostomy demonstrates significantly lower adverse event rates (13.4%) compared to surgical gastrojejunostomy (33.3%) 7
- Technical success rates for EUS-guided procedures are approximately 88-97.9% 4, 7
- Clinical success is achieved in 85-94% of cases 4, 5
Clinical Context and Pitfalls
The primary pitfall would be confusing bypass procedures with resection procedures when counseling patients about intestinal failure risk. Intestinal failure requires a remnant small bowel length of less than 150-200 cm from repeated resections 2. Since EUS-guided jejuno-sigmoidostomy does not remove any bowel, this complication cannot occur from the procedure itself.
Important Caveats
- Patients requiring this procedure may have underlying malignancy or conditions that could independently lead to bowel dysfunction, but this would not be attributable to the bypass procedure 2, 3
- Water and electrolyte management issues seen with jejunostomies and ileostomies (hyponatremia, volume depletion) occur because of ostomy output, not from bypass procedures 1
- Multidisciplinary support including interventional radiology, surgery, and anesthesiology should be available at centers performing advanced EUS procedures to manage potential complications 2