Tightening the purse strings: a stent-free path to a lasting endoscopic gastroenterostomy

A 42-year-old woman presented with epigastric abdominal pain for several years. An extensive workup revealed duodenal compression on esophagogastroduodenoscopy (EGD) and superior mesenteric artery syndrome on imaging ([Fig. 1]). Despite several months of conservative management, the patient remained symptomatic. She deferred surgery and was then offered an endoscopic ultrasound-guided gastroenterostomy (EUS-GE) ([Video 1]).