Endoscopic ultrasound guided gastroenterostomy: Technical details updates, clinical outcomes, and adverse events

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Abstract

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has been transformed from an innovative technique, into a viable alternative to enteral stenting and surgical gastrointestinal anastomosis for patients with gastric outlet obstruction. Even EUS-GE guided ERCP and EUS-guided gastrointestinal anastomosis for the treatment of afferent loop syndrome have been performed, giving patients more less invasive options. However, EUS-GE is still a technically challenging procedure. In order to improve EUS-GE, several techniques have been reported to improve the technical details. With EUS-GE widely performed, more data about EUS-GE’s clinical outcomes have been reported. The aim of the current review is to describe technical details updates, clinical outcomes, and adverse events of EUS-GE.

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EUS-Guided Gastroenterostomy versus Enteral Stent Placement for Palliation of Malignant Gastric Outlet Obstruction

Phillip S Ge, Joyce Young, William Dong … (2019)

EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO), however data comparing EUS-GE to enteral stent placement is limited. We aimed to compare clinical outcomes between EUS-GE and enteral stent placement in the palliation of malignant GOO. Retrospective analysis of a prospectively collected database on patients who underwent EUS-GE or enteral stent placement for palliation of malignant GOO from 2014–2017. Primary outcome was the rate of stent failure requiring repeat intervention. Secondary outcomes included technical and clinical success, time to repeat intervention, length of hospital stay, and adverse events. A total of 100 consecutive patients (mean age 65.9±11.9 years, 44.0% female) were identified, of which 78 underwent enteral stent placement, and 22 underwent EUS-GE. Rate of stent failure requiring repeat intervention was higher in the enteral stent group than the EUS-GE group (32.0% vs 8.3%, p =0.021). Technical success was achieved in 100% in both groups. Higher initial clinical success was attained in the EUS-GE group than the enteral stent group (95.8% vs 76.3%, p =0.042). Mean length of hospital stay following stent placement was similar between groups ( p =0.821). The enteral stent group trended towards increased adverse events (40.2% vs 20.8%, p =0.098). Kaplan-Meier analysis showed decreased stent function in the enteral stent group ( p =0.013). Compared to enteral stent placement, EUS-GE has a higher rate of initial clinical success and lower rate of stent failure requiring repeat intervention. EUS-GE may be offered for selected patients with malignant GOO in centers with extensive experience.

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EUS-guided Gastrojejunostomy Versus Laparoscopic Gastrojejunostomy: An International Collaborative Study.

Manuel Pérez-Miranda, Amy Tyberg, Daniel Poletto … (2017)

Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) with placement of a lumen-apposing metal stent is a minimally invasive and efficacious procedure for gastric outlet obstruction (GOO) patients not amenable to surgery. Laparoscopic gastrojejunostomy (Lap-GJ) has traditionally been the standard of care. No direct comparison between EUS-GJ and Lap-GJ has been described. Our aim was to compare the clinical outcomes, success rate, and adverse events (AE) of EUS-GJ with Lap-GJ.

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International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction

Mouen Khashab, Majidah Bukhari, Todd Baron … (2017)

Background and study aims EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers long-lasting luminal patency without the risk of tumor ingrowth/overgrowth. This study compared the clinical success, technical success, adverse events (AEs), length of hospital stay (LOHS) and symptom recurrence in EUS-GE versus SGJ. Methods This was a multicenter international retrospective comparative study of EUS-GE and SGJ in patients with malignant gastric outlet obstruction (GOO) who underwent either EUS-GE or SGJ. EUS-GE was performed using lumen apposing metal stents. Results A total of 93 patients with malignant GOO treated with either EUS-GE (n = 30) or SGJ (n = 63) were identified. Peritoneal carcinomatosis was present in 13 (43 %) patients in the EUS-GE group and 7 (11 %) patients in the SGJ group (P < 0.001). Although the technical success rate was significantly higher in the SGJ group as compared to the EUS-GE group (100 % vs. 87 %, P = 0.009), the clinical success rate was not different (90 % vs. 87 %, P = 0.18, OR 0.8, 95 %CI 0.44 – 7.07). The rate of AEs was lower in the EUS-GE group, but the difference was not statistically significant (16 % vs 25 %, P = 0.3). The mean LOHS was similar in the EUS-GE group compared to SGJ (P = 0.35). The rate of recurrent GOO was not different between the two groups (3 % vs. 14 %, P = 0.08). Similarly, the mean time to reintervention was similar (88 days vs. 121 days, P = 0.83). Conclusions EUS-GE is associated with equivalent efficacy and safety as compared to surgical GJ. This is the first comparative trial between both techniques and suggests EUS-GE as a non-inferior but less invasive alter to surgery.

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Author and article information

Contributors

Jian Wang

Jin-Long Hu

Si-Yu Sun

Journal

Journal ID (nlm-ta): World J Gastrointest Endosc

Journal ID (publisher-id): WJGE

Title: World Journal of Gastrointestinal Endoscopy

Publisher: Baishideng Publishing Group Inc

ISSN (Electronic): 1948-5190

Publication date (Print): 16 November 2023

Publication date (Electronic): 16 November 2023

Volume: 15

Issue: 11

Pages: 634-640

Affiliations

Department of Gastroenterology, People's Hospital of Shenyang Economic and Technological Development Zone, Shenyang 110001, Liaoning Province, China

Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China

Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China. sun-siyu@ 123456163.com

Author notes

Author contributions: Wang J and Hu JL designed and wrote the manuscript; Sun SY reviewed the manuscript; all authors have read and approve the final manuscript.

Corresponding author: Si-Yu Sun, PhD, Director, President, Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, Liaoning Province, China. sun-siyu@ 123456163.com

Article

Other ID: jWJGE.v15.i11.pg634 Publisher-manuscript ID: 87431

DOI: 10.4253/wjge.v15.i11.634

PMC ID: 10698333

PubMed ID: 38073765

SO-VID: 896c22a1-4c67-4dd4-9a87-b812c1420aec

License:

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

History

Date received : 9 August 2023

Date revision received : 12 September 2023

Date accepted : 23 October 2023

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