Hybrid Gastroenterostomy Using A Lumen-Apposing Metal Stent: A Case Report Focusing On Misdeployment.

2021 ◽  
Author(s):  
Carlo Fabbri ◽  
Cecilia Binda ◽  
Paola Fugazzola ◽  
Monica Sbrancia ◽  
Matteo Tomasoni ◽  
...  
Keyword(s):  
Case Report ◽  
Gastric Outlet Obstruction ◽  
Endoscopic Ultrasound ◽  
Duodenal Bulb ◽  
Outlet Obstruction ◽  
Jejunal Loop ◽  
Endoscopic Stenting ◽  
Hybrid Technique ◽  
Metal Stent ◽  
Ultrasound Guided

Abstract BackgroundGastric outlet obstruction can result from several benign and malignant diseases, in particular gastric, duodenal or pancreatic tumors. Historically, surgical gastroenterostomy and enteral endoscopic stenting have represented effective therapeutic options. However, surgery is burdened by high complication and mortality rates, while endoscopic stenting demonstrates unsatisfactory patency after six months. Lately, endoscopic ultrasound-guided gastroenterostomy using lumen apposing metal stent (LAMS) is spreading in order to improve the outcome of this condition, but still complication rate remains not negligible. Our case report shows a hybrid (endoscopic and surgical) technique for LAMS deployment, reviews current literature on potential complications and demonstrates problem solving strategies. Case presentationA 60 year-old male patient, affected by metastatic pancreatic adenocarcinoma, developed gastric outlet obstruction due to a duodenal bulb stenosis. Endoscopic ultrasound-guided gastroenterostomy was performed in an operating room, but the first flange of LAMS was misdeployed opening in the epiploon retrocavity. Immediate diagnostic laparoscopy was carried out, LAMS was removed endoscopically and the first jejunal loop was identified by laparoscopy. The jejunal loop was placed near the stomach, allowing for endoscopic release of a second LAMS through the previous fistulous gastric tract, performing a laparoscopy-assisted gastroenterostomy.ConclusionsThis hybrid technique may offer an innovative strategy to overcome misdeployment of LAMS, which represents the most troubling complication of endoscopic ultrasound-guided approach. There are several significant advantages, such as the easy visualization of target loop and cystostome penetration, nevertheless the ability to considerably shorten overall procedure time.

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.

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 gastrojejunostomy as a rescue therapy for gastric outlet obstruction in a patient with multiple previous procedures

Endoscopy ◽  
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

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.

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