Su1362 LONG-TERM OUTCOMES OF ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY USING LUMEN-APPOSING METAL STENTS FOR GASTRIC OUTLET OBSTRUCTION: A 4-YEAR COHORT

Abstract Background and study aims EUS-guided gastroenterostomy (GE) is a novel, minimally invasive endoscopic procedure for the treatment of gastric outlet obstruction (GOO). The direct-EUS-GE (D-GE) approach has recently gained traction. We aimed to report on a large cohort of patients who underwent DGE with focus on long-term outcomes. Patients and methods This two-center, retrospective study involved consecutive patients who underwent D-GE between October 2014 and May 2018. The primary outcomes were technical and clinical success. Secondary outcomes were adverse events (AEs), rate of reintervention, procedure time, time to resume oral diet, and post-procedure length of stay (LOS). Results A total of 57 patients (50.9 % female; median age 65 years) underwent D-GE for GOO. The etiology was malignant in 84.2 % and benign in 15.8 %. Technical success and clinical success were achieved in 93 % and 89.5 % of patients, respectively, with a median follow-up of 196 days in malignant GOO and 319.5 days in benign GOO. There were 2 (3.5 %) AEs, one severe and one moderate. Median procedure time was 39 minutes (IQR, 26 – 51.5 minutes). Median time to resume oral diet after D-GE was 1 day (IQR 1 – 2 days). Median post D-GE LOS was 3 days (IQR 2 – 7 days). Rate of reintervention was 15.1 %. Conclusions D-GE is safe and effective in management of both malignant and benign causes of GOO. Clinical success with D-GE is durable with a low rate of reintervention based on a long-term cohort.

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ID: 3518992 ANTEGRADE VERSUS RETROGRADE ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY USING LUMEN-APPOSING METAL STENTS FOR THERAPY OF MALIGNANT AND BENIGN GASTRIC OUTLET OBSTRUCTION: A MULTICENTER, COMPARATIVE TRIAL

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2021.03.499 ◽

2021 ◽

Vol 93 (6) ◽

pp. AB226-AB227

Author(s):

Varun Kesar ◽

Youseung Kim ◽

Monique T. Barakat ◽

Adrew Ofosu ◽

Joo Ha Hwang ◽

...

Keyword(s):

Gastric Outlet Obstruction ◽

Endoscopic Ultrasound ◽

Outlet Obstruction ◽

Comparative Trial ◽

Metal Stents ◽

Ultrasound Guided

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Modified endoscopic ultrasound-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS): a pilot study

Endoscopy ◽

10.1055/a-1392-4546 ◽

2021 ◽

Author(s):

Amanda Marino ◽

Ali Bessissow ◽

Corey Miller ◽

David Valenti ◽

Louis Boucher ◽

...

Keyword(s):

Gastric Outlet Obstruction ◽

Endoscopic Ultrasound ◽

Clinical Success ◽

Outlet Obstruction ◽

Stent Migration ◽

Stent Insertion ◽

Ultrasound Guided ◽

Double Balloon ◽

Low Residue Diet ◽

The Mean

Abstract Introduction We recently developed a double-balloon device, using widely available existing technology, to facilitate endoscopic ultrasound-guided gastroenterostomy (EUS-GE). Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS). Methods This was a single-center retrospective study of consecutive patients undergoing M-EPASS from January 2019 to August 2020. The double-balloon device consists of two vascular balloons that optimize the distension of a targeted small-bowel segment for EUS-guided stent insertion. The primary end point was the rate of technical success. Results 11 patients (45 % women; mean [standard deviation (SD)] age 64.9 [8.6]) with malignant gastric outlet obstruction were included. Technical and clinical success (ability to tolerate an oral diet) were achieved in 91 % (10/11) and 80 % (8/10) of patients, respectively. There was one adverse event (9 %) due to stent migration. Two patients (18 %) required re-intervention for stent obstruction secondary to food impaction. The mean (SD) time to a low residue diet was 3.5 (2.4) days. Conclusion M-EPASS appears to facilitate the technique of EUS-GE, potentially enhancing its safety and clinical adoption. Larger studies are needed to validate this innovative approach to gastric outlet obstruction.

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Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

Endoscopy International Open ◽

10.1055/a-1214-5659 ◽

2020 ◽

Vol 08 (09) ◽

pp. E1194-E1201 ◽

Cited By ~ 1

Author(s):

Janine B. Kastelijn ◽

Leon M.G. Moons ◽

Francisco J. Garcia-Alonso ◽

Manuel Pérez-Miranda ◽

Viliam Masaryk ◽

...

Keyword(s):

Gastric Outlet Obstruction ◽

Endoscopic Ultrasound ◽

Palliative Treatment ◽

Clinical Success ◽

Outlet Obstruction ◽

Invasive Technique ◽

Technical Success ◽

Ultrasound Guided ◽

Malignant Gastric Outlet Obstruction

Abstract Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) is a novel, minimally invasive technique in the palliative treatment of malignant gastric outlet obstruction (GOO). Several studies have demonstrated feasibility and safety of EUS-GE, but evidence on long-term durability is limited. The aim of this study was to evaluate patency of EUS-GE in treatment of malignant GOO. Patients and Methods An international multicenter study was performed in seven centers in four European countries. Patients who underwent EUS-GE with a LAMS between March 2015 and March 2019 for palliative treatment of symptomatic malignant GOO were included retrospectively. Our main outcome was recurrent obstruction due to LAMS dysfunction; other outcomes of interest were technical success, clinical success, adverse events (AEs), and survival. Results A total of 45 patients (mean age 69.9 ± 12.3 years and 48.9 % male) were included. Median duration of follow-up was 59 days (interquartile range [IQR] 41–128). Recurrent obstruction occurred in two patients (6.1 %), after 33 and 283 days of follow-up. Technical success was achieved in 39 patients (86.7 %). Clinical success was achieved in 33 patients (73.3 %). AEs occurred in 12 patients (26.7 %), of which five were fatal. Median overall survival was 57 days (IQR 32–114). Conclusions EUS-GE showed a low rate of recurrent obstruction. The relatively high number of fatal AEs underscores the importance of careful implementation of EUS-GE in clinical practice.

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Endoscopic ultrasound-guided gastrojejunostomy as a rescue therapy for gastric outlet obstruction in a patient with multiple previous procedures

Endoscopy ◽

10.1055/a-1216-1330 ◽

2020 ◽

Author(s):

Enrique Pérez-Cuadrado-Robles ◽

Guillaume Perrod ◽

Hédi Benosman ◽

Emilia Ragot ◽

Claire Gallois ◽

...

Keyword(s):

Gastric Outlet Obstruction ◽

Endoscopic Ultrasound ◽

Rescue Therapy ◽

Outlet Obstruction ◽

Ultrasound Guided

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Conservative management of malignant gastric outlet obstruction syndrome-evidence based evaluation of endoscopic ultrasound-guided gastroentero-anastomosis

World Journal of Gastrointestinal Oncology ◽

10.4251/wjgo.v13.i9.1086 ◽

2021 ◽

Vol 13 (9) ◽

pp. 1086-1098

Author(s):

Anna Cominardi ◽

Giacomo Tamanini ◽

Nicole Brighi ◽

Pietro Fusaroli ◽

Andrea Lisotti

Keyword(s):

Gastric Outlet Obstruction ◽

Endoscopic Ultrasound ◽

Conservative Management ◽

Outlet Obstruction ◽

Evidence Based ◽

Ultrasound Guided ◽

Malignant Gastric Outlet Obstruction

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Endoscopic Ultrasound-guided Gastroenterostomy: A Promising Alternative to Surgery

Journal of Translational Internal Medicine ◽

10.2478/jtim-2019-0021 ◽

2019 ◽

Vol 7 (3) ◽

pp. 93-99 ◽

Cited By ~ 5

Author(s):

Guoxin Wang ◽

Xiang Liu ◽

Sheng Wang ◽

Nan Ge ◽

Jintao Guo ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Outlet Obstruction ◽

Metal Stents ◽

Success Rates ◽

Ultrasound Guided ◽

Traditional Treatment ◽

Promising Alternative ◽

Prolonged Hospital ◽

Surgical Adverse Events ◽

Guided Therapy

Abstract Recently, with the advancement of techniques, endoscopic ultrasound-guided therapies have shown distinct advantages, especially in relieving benign and malignant gastric outlet obstruction (GOO), as well as in postoperative pancreaticobiliary diseases. Herein, we present five currently used approaches in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumenapposing biflanged metal stents (LAMS), along with several examples of LAMS-based EUS treatment of pancreaticobiliary diseases. Compared with traditional treatment methods, EUS-guided procedures have – to some degree – shown higher success rates, both technical and clinical. Moreover, EUS-guided therapies reduce the risk of multiple surgical adverse events, including delayed gastric emptying, prolonged hospital stay, increased costs, and delay in cancer treatment. Particularly in terms of postoperative pancreaticobiliary diseases, EUS-guided therapy has assumed an essential role as a treatment option in cases where traditional methods are difficult to perform. Nevertheless, EUS-guided gastrointestinal procedures are still relatively new, with some clinical failures, and additional prospective clinical trials are warranted.

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