Small-bowel obstruction (SBO) is typically managed with gastric decompression and intravenous hydration; however, when conservative management fails, opera- tive management is necessary. 1 In cases of extrinsic compression from adhesive disease, laparotomy with lysis of adhesions is often required. 2 Patients with high-grade obstruction who do not proceed to operative management are at risk for bowel perforation and septic shock from peritonitis. 3 However, many patients either fail operative management or are not candidates for surgery because of comorbidities. 4 Endoscopic management of distal SBO is most effective in short strictures without high-grade obstruction. 5 A nonsurgical method for treating SBO in patients unfit for surgery has the potential to improve clinical outcomes for a challenging patient population. The aim of this video (Video 1, available online atwww.VideoGIE.org)wastodescribetheEUS-directedileo- colonicanastomosistechniqueinthenonoperative manage- ment of distal SBO.
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