Abstract
Background and aim
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for the treatment of gastric
outlet obstruction (GOO) has been actually performed only with one type of electrocautery
lumen-apposing metal stents (EC-LAMS). We aimed to evaluate the safety, technical
and clinical effectiveness of EUS-GE using a newly available EC-LAMS in patients with
malignant and benign GOO.
Materials and methods
Consecutive patients who underwent EUS-GE for GOO using the new EC-LAMS at five endoscopic
referral centers were retrospectively evaluated. Clinical efficacy was determined
utilizing the Gastric Outlet Obstruction Scoring System (GOOSS).
Results
Twenty-five patients (64% male, mean age 68.7 ± 9.3 years) met the inclusion criteria;
21 (84%) had malignant etiology. Technically, EUS-GE was successful in all patients,
with a mean procedural time of 35 ± 5 min. Clinical success was 68% at 7 days and
100% at 30 days. The mean time to resume oral diet was 11.4 ± 5.8 h, with an improvement
of at least one point of GOOSS score observed in all patients. The median hospital
stay was 4 days. No procedure-related adverse events occurred. After a mean follow-up
of 7.6 months (95% CI 4.6–9.2), no stent dysfunctions were observed.
Conclusion
This study suggests EUS-GE can be performed safely and successfully using the new
EC-LAMS. Future large multicenter prospective studies are needed to confirm our preliminary
data.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial.Gastrointest Endosc. 2010; 71: 490-499
- ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction.Gastrointest Endosc. 2021; 93: 309-322
- Long-term results of balloon catheter dilation for benign gastric outlet stenosis.Endoscopy. 2003; 35: 490-495
- Self-expanding metallic stents for continuous dilatation of benign stenoses in gastrointestinal tract - first results of long-term follow-up in interim stent application in pyloric and colonic obstructions.Z Gastroenterol. 2001; 39: 957-960
- Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction.Cochrane Database Syst Rev. 2018; 5CD012506
- Development and validation of a risk score for prediction of clinical success after duodenal stenting for malignant gastric outlet obstruction.Expert Rev Gastroenterol Hepatol. 2022; 16: 393-399
- Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study.Endoscopy. 2012; 44: 499-503
- EUS-guided gastroenterostomy in management of benign gastric outlet obstruction [published correction appears in Endosc Int Open 2018 Mar;6(3):C3].Endosc Int Open. 2018; 6: E363-E368
- EUS-guided gastroenterostomy versus surgical gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis.Endosc Int Open. 2022; 10: E448-E458
- Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for malignant gastric outlet obstruction: an international, multicenter, propensity score-matched comparison [published online ahead of print, 2022].Endoscopy. 2022;
- A novel electrocautery-enhanced delivery system for one-step endoscopic ultrasound-guided drainage of the gallbladder and bile duct using a lumen-apposing metal stent: a feasibility study.Endoscopy. 2021; 53: 922-926
- Endoscopic ultrasound guided biliary drainage in malignant distal biliary obstruction.Cancers. 2023; 15 (Basel): 490
- Safety and efficacy of a novel electrocautery-enhanced lumen-apposing metal stent in interventional EUS procedures.Gastrointest Endosc. 2022;
- EUS-guided biliary drainage with a novel electrocautery-enhanced lumen apposing metal stent as first approach for distal malignant biliary obstruction: a prospective study.Endosc Int Open. 2022; 10: E998-1003
- A novel lumen apposing metal stent with an electrocautery-tip for different indications: initial experience in a referral center.Dig Dis. 2021; 4: 1-7
- Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients.Am J Gastroenterol. 2002; 97: 72-78
- Therapeutic endoscopic ultrasound: european Society of Gastrointestinal Endoscopy (ESGE) Technical Review.Endoscopy. 2022; 54: 310-332
- Therapeutic endoscopic ultrasound: european Society of Gastrointestinal Endoscopy (ESGE) Guideline.Endoscopy. 2022; 54: 185-205
- EUS-guided gastroenterostomy: less is more! The wireless EUS-guided gastroenterostomy simplified technique.VideoGIE. 2020; 5: 442
- Novel classification for adverse events in GI endoscopy: the AGREE classification.Gastrointest Endosc. 2022; 95: 1078-1085
- EUS-guided gastroenterostomy versus surgical gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis.Endosc Int Open. 2022; 10: E448-E458
- Clinical and technical outcomes of patients undergoing endoscopic ultrasound-guided gastroenterostomy using 20-mm vs. 15-mm lumen-apposing metal stents [published correction appears in Endoscopy 2022].Endoscopy. 2022; 54: 680-687
- EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction.Surg Endosc. 2019; 33: 3404-3411
- EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction.Surg Endosc. 2017; 31: 2946-2952
- Laparoscopic versus EUS-guided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score-matched comparison (with video).Gastrointest Endosc. 2021; 94 (526-36.e2)
- Endoscopic ultrasound-guided gastroenterostomy using large-diameter (20 mm) lumen apposing metal stent (LLAMS).Endosc Int Open. 2021; 9: E895-E900
- EUS-guided gastro-enteral anastomosis for the treatment of gastric outlet obstruction: is the end of the enteral stent?.Expert Rev Gastroenterol Hepatol. 2022; 16: 587-589
Article info
Publication history
Published online: March 06, 2023
Accepted:
February 14,
2023
Received:
November 9,
2022
Publication stage
In Press Corrected ProofFootnotes
Ethical approval to conduct this study was obtained on 07/19/2022 (protocol number n. 38/22 HMD).
Identification
Copyright
© 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.