Endoscopic ultrasound-guided gastroenterostomy using an oroenteric catheter-assisted technique: a retrospective analysis

Endoscopy ◽  
2021 ◽  
Author(s):  
Nam Q. Nguyen ◽  
Christopher M. Hamerski ◽  
Andrew Nett ◽  
Rabindra R. Watson ◽  
Morgan Rigopoulos ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Symptom Relief ◽  
Outlet Obstruction ◽  
Oral Intake ◽  
Metal Stent ◽  
Technical Success ◽  
Ultrasound Guided

Abstract Background This study evaluated an oroenteric catheter (OEC)-assisted technique to distend the enteric loop for endoscopic ultrasound-guided gastroenterostomy (EUS-GE) in patients with gastric outlet obstruction (GOO). Methods Patient outcomes were reviewed. Proximal enteric loops were filled with water via an OEC (7 Fr or 8 Fr), providing a target for EUS-GE using a lumen-apposing metal stent (15-mm caliber). Clinical success was defined as toleration of a non-liquid diet by Day 3. Results 42 patients (mean age 73.1 [SEM 2.8] years; 23 male) underwent EUS-GE for malignant (n = 37) and benign (n = 5) duodenal strictures. EUS-GE creation was successful in 41/42 (98 %), with mean procedure time of 36 (SEM 3) minutes and no serious complications. Clinical success was achieved in 39/42 (93 %) at 5.7 (SEM 2.6) months’ follow-up. Of 14 patients who died, 13 (93 %) maintained oral intake until death. EUS-GE provided good symptom relief in all 28 surviving patients until follow-up. Conclusions OEC-assisted EUS-GE provided satisfactory relief of GOO symptoms, with high technical success (98 %) and no serious complications.

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

2020 ◽  
Vol 08 (09) ◽  
pp. E1194-E1201 ◽  
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.

scholarly journals Endoscopic ultrasound-guided gastroenterostomy using large-diameter (20 mm) lumen apposing metal stent (LLAMS)

2021 ◽  
Vol 09 (06) ◽  
pp. E895-E900
Author(s):  
Zain A. Sobani ◽  
Swathi Paleti ◽  
Tarun Rustagi
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Large Diameter ◽  
Outlet Obstruction ◽  
Jejunal Ulcer ◽  
Metal Stent ◽  
Ultrasound Guided ◽  
Regular Diet

Abstract Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a 15-mm lumen apposing metal stent (LAMS) has emerged as a viable alternative to surgical gastrojejunostomy for management of gastric outlet obstruction (GOO). However, given the size of the anastomosis created with a 15-mm LAMS, long-term luminal patency and clinical outcomes may be suboptimal. The aim of this study was to evaluate the technical feasibility, efficacy, and safety of EUS-GE with a large-diameter (20 mm) LAMS (LLAMS). Patients and methods A retrospective analysis of a prospectively maintained database of all patients undergoing EUS-GE with LLAMS between December 1, 2018 and September 30, 2020 was performed. All EUS-GEs were performed using a cautery-enhanced LLAMS. Results Thirty-three patients were referred for endoscopic management of GOO. Two patients were excluded due to a lack of an adequate window for EUS-GE. The remaining 31 patients (93.94 %) (mean age: 61.35 ± 16.52 years; 54.84 % males) underwent EUS-GE using LLAMS for malignant (n = 23) and benign (n = 8) GOO. Technical success was achieved in all patients (100 %) with attempted EUS-GE. Complete clinical success (tolerance of regular diet) was achieved in 93.55 % of patients (n = 29). Two patients (6.45 %) had partial clinical success and died of unrelated causes prior to advancing diet beyond full liquids. Overall mean follow-up was 140.84 ± 160.41 days (median 70, range 4–590). All stents remained patent with no evidence of recurrent GOO symptoms. One patient (3.23 %) developed an asymptomatic clean-based jejunal ulcer on 3-month follow-up endoscopy. Conclusions EUS-GE with LLAMS is a technically feasible, effective and safe option for patients with GOO allowing for tolerability of regular diet. Future prospective, ideally randomized studies comparing long-term outcomes of EUS-GE with 20- and 15-mm LAMS are required.

Clinical and Technical Outcomes of patients undergoing EUS-Guided Gastroenterostomy using 20 mm vs 15 mm LAMS

Endoscopy ◽  
2021 ◽  
Author(s):  
Michael Bejjani ◽  
Bachir Ghandour ◽  
Jose Carlos Subtil ◽  
Belén Martínez ◽  
Reem Z Sharaiha ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Primary Outcome ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Metal Stent ◽  
Technical Success ◽  
Malignant Gastric Outlet Obstruction ◽  
Complete Diet ◽  
Secondary Outcomes

Background/Aims: The majority of studies on EUS-guided gastroenterostomy (EUS-GE) for palliation of malignant gastric outlet obstruction (GOO) have utilized a 15mm lumen apposing metal stent (LAMS). More recently, a 20mm LAMS has become available. The aim of this study was to compare rates of technical and clinical success, and adverse events (AEs) in patients undergoing EUS-GE using a 20mm vs 15mm LAMS. Methods: Patients who underwent EUS-GE with 15mm or 20mm LAMS for malignant GOO during the period of 1/2018-10/2020 were included. The primary outcome was clinical success, defined as an increase in the gastric outlet obstruction score (GOOS) by at least 1 point during follow-up. Secondary outcomes were technical success, maximum tolerated diet, rate of reintervention, and the rate/severity of AEs. Results: A total of 267 patients (mean age 67yr, F 43%) with malignant GOO from 19 centers underwent EUS-GE. The rate of clinical success was similar between the 15mm and 20mm stents (89.2% [95% CI 84.2-94.2] vs 84.1% [95%CI 77.4-90.6]). However, a significantly higher proportion of patients in the 20mm group tolerated a soft solid/complete diet at the end of follow-up (91.2% [95%CI 84.4-95.7] vs 81.2% [95%CI 73.9-87.2] p=0.04). Overall, AEs occurred in 33 (12.4% [95%CI 8.4-16.3]) patients, with rates being similar between 15mm and 20mm stents (12.8% [95%CI 7.5-18.2] vs 11.8% [95%CI 6-17.6]), including incidence of severe/fatal AEs (2% [95%CI 0.4-5.8] vs 3.4% [95%CI 0.9-8.4]). Conclusions: The 20mm LAMS is similar to the 15mm LAMS in terms of safety and efficacy for patients undergoing EUS-GE for malignant GOO. The 20 mm LAMS allows a more advanced diet and is, thus, the preferred LAMS during EUS-GE.

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

Endoscopy ◽  
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.

Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience

Endoscopy ◽  
2018 ◽  
Vol 50 (09) ◽  
pp. 891-895 ◽  
Author(s):  
Olaya Brewer Gutierrez ◽  
Shayan Irani ◽  
Saowanee Ngamruengphong ◽  
Hanaa Aridi ◽  
Rastislav Kunda ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Indirect Comparison ◽  
Procedure Time ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Common Procedure ◽  
Afferent Loop ◽  
Afferent Loop Syndrome

Abstract Background Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE. Methods This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected. Results 18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6 % vs. 76.5 %; P < 0.001). Conclusion EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.

scholarly journals Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

2020 ◽  
Vol 08 (11) ◽  
pp. E1664-E1672
Author(s):  
Saurabh Chandan ◽  
Babu P. Mohan ◽  
Shahab R. Khan ◽  
Lena L. Kassab ◽  
Suresh Ponnada ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Anastomotic Strictures ◽  
Pancreatic Duct Drainage

Abstract Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval. Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6). Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

Long-term placement of lumen-apposing metal stent after endoscopic ultrasound-guided duodeno- and jejunojejunal anastomosis for direct access to excluded jejunal limb

Endoscopy ◽  
2020 ◽  
Author(s):  
Gianfranco Donatelli ◽  
Fabrizio Cereatti ◽  
Andrea Spota ◽  
David Danan ◽  
Thierry Tuszynski ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Endoscopic Ultrasound ◽  
Direct Access ◽  
Metal Stent ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Indwelling Time ◽  
Stricture Recurrence

Abstract Background Management of biliary disorders in patients with altered anatomy may be challenging. Endoscopic ultrasound (EUS)-guided gastrointestinal anastomosis using a lumen-apposing metal stent (LAMS) was introduced to allow endoscopic retrograde cholangiography (ERC) in such cases. However, the appropriate stent indwelling time remains uncertain. We report long-term LAMS deployment after duodenojejunal or jejunojejunal anastomosis (EUS-DJA) to allow endoscopic reinterventions in cases of recurrences. Methods 11 consecutive patients underwent EUS-DJA with long-standing LAMS between January 2017 and December 2018. Over a 12-month period, ERC treatment was carried out with multiple endoscopic sessions across the DJA. Results Technical success was 91 % (10/11) for EUS-DJA and 100 % for ERC. Four patients presented stricture recurrence at a mean of 489 days (standard deviation [SD] 31.7) after the end of ERC treatment. A novel ERC across the LAMS anastomosis was feasible in all cases. At a mean of 781 days (SD 253.1), all LAMS remained in place with no evidence of complications. Conclusion Long-term LAMS placement after EUS-DJA may be feasible and safe for direct access to the excluded limb.

scholarly journals Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a silicone-covered nitinol short bilaterally flared stent: a case series

2017 ◽  
Vol 05 (11) ◽  
pp. E1111-E1116 ◽  
Author(s):  
Raffaele Manta ◽  
Claudio Zulli ◽  
Angelo Zullo ◽  
Edoardo Forti ◽  
Alberto Tringali ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Symptom Relief ◽  
Case Series ◽  
Metal Stents ◽  
Success Rates ◽  
Gallbladder Drainage ◽  
First Case

Abstract Background and study aim Gallbladder drainage in patients with cholecystitis who are unsuitable for surgery may be performed by endoscopic ultrasound (EUS)-guided placement of specifically designed fully covered metal stents. We describe the first case series of patients treated with a silicone-covered nitinol stent with bilateral anchor flanges. Patients and methods Data from consecutive patients with acute cholecystitis who were deemed unsuitable candidates for surgery were collected. The stent placement procedure was performed in two tertiary endoscopy centers by four experienced endoscopists. Technical and clinical success rates, as well as adverse events and clinical outcome at follow-up, were assessed. Results EUS-guided drainage for cholecystitis was performed in 16 patients (mean age 84 years; nine males). Technical and clinical success rates were 100 % (16/16) and 94 % (15/16), respectively; an early failure due to stone impaction occurred in the remaining case and required placement of a new stent. Symptom relief occurred in 11/15 cases (73 %) within 1 day, and within 2 days in the remaining 4 patients. Bleeding occurred in two patients (13 %): in one patient intraprocedural bleeding was successfully stopped during endoscopy; and delayed bleeding occurred in one patient requiring arterial embolization for catastrophic bleeding (patient died 10 days later). No cases of cholecystitis recurrence or biliary obstruction were observed during a median follow-up of 112 days (range 49 – 180 days). Conclusions Our data showed that EUS-guided gallbladder drainage with a specially designed stent is feasible and successful in patients with acute cholecystitis who are unfit for surgery.

Peroral cholecystoscopy using a multibending ultraslim endoscope through a lumen-apposing metal stent for endoscopic ultrasound-guided gallbladder drainage: a feasibility study

Endoscopy ◽  
2021 ◽  
Author(s):  
Hae Won Yoo ◽  
Jong Ho Moon ◽  
Yun Nah Lee ◽  
Yeon Han Song ◽  
Jae Kook Yang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Primary Outcome ◽  
Narrow Band Imaging ◽  
Endoscopic Examination ◽  
Metal Stent ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Gallbladder Drainage ◽  
Technical Success Rate

Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS) has rendered endoscopic gallbladder assessment through a stent possible, but an appropriate endoscope is required. We assessed the feasibility of peroral cholecystoscopy (POCC) using a multibending ultraslim endoscope passed through a LAMS after EUS-GBD. Methods 14 patients with a LAMS for EUS-GBD who consecutively underwent POCC were included. POCC was performed using a multibending endoscope inserted through the LAMS. The primary outcome was the technical success rate, defined as complete endoscopic examination of the gallbladder from the orifice of the cystic duct to the fundus. The types of intervention and adverse events were recorded. Results 17 POCCs were performed in 14 patients. Of the 17 POCCs, 15 (88.2 %) were technically successful. Narrow-band imaging endoscopy was performed in 12 procedures (70.6 %), and cholecystoscopy-guided target biopsies were obtained in six. Gallstone extraction was performed in two patients. After POCC, all LAMSs remained stable and no adverse events were observed. Conclusions POCC using a multibending ultraslim endoscope can be effectively and safely performed through a LAMS after EUS-GBD.

scholarly journals Gastric outlet obstruction with ascites: EUS-guided gastro-enterostomy is feasible

2021 ◽  
Vol 09 (12) ◽  
pp. E1918-E1923
Author(s):  
Jahangeer Basha ◽  
Sundeep Lakhtakia ◽  
Raghavendra Yarlagadda ◽  
Zaheer Nabi ◽  
Rajesh Gupta ◽  
...  
Keyword(s):  
Adverse Events ◽  
Gastric Outlet Obstruction ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Survival Times ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Underlying Malignancy ◽  
Study Population ◽  
Free Hand Technique

Abstract Background and study aims Endoscopic ultrasound-guided gastro-enterostomy(EUS-GE) is a recently described novel minimally invasive endoscopic procedure for patients having malignant gastric outlet obstruction (GOO). The safety of EUS-GE in the presence of ascites with GOO is not known. The objective of the study was to evaluate the feasibility and safety of EUS-GE in patients with GOO and ascites. Patients and methods Consecutive patients with GOO who underwent EUS-GE between January 2019 and March 2021 constituted the study population. EUS-GE was performed using either EPASS or free-hand technique. The technical success, clinical success, adverse events, and survival times were evaluated. The outcomes were compared between patients with and without ascites. Results A total of 31 patients with GOO underwent EUS-GE of whom 29 (93.5 %) had malignant and two (6.4 %) had benign etiologies. Ascites was observed in 12 out of 31 (38.7%) patients and all had underlying malignancy. Majority (27, 87 %) of the EUS-GE procedures were performed using EPASS technique, and 4 (13 %) underwent free-hand technique. Eleven of 12 patients with ascites and GOO underwent EUS GE using EPASS technique. The technical success (91.6 % vs. 89.4 %; P = 0.841), clinical success (83.3 % vs. 89.4 %; P = 0.619), mean procedure time (32 vs. 31.6 min; P = 0.968) and adverse events (0 % vs. 10.5 %; P = 0.245) were not significantly different between patients with or without ascites. However, the median survival time was significantly low in patients with ascites when compared to without ascites (36 vs. 290 days; P < 001). Conclusions Ascites is a common occurrence in patients with malignant GOO. EUS GE is feasible in presence of ascites with EPASS technique.

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