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. 2018 Mar;6(3):E363-E368.
doi: 10.1055/s-0043-123468. Epub 2018 Mar 7.

EUS-guided gastroenterostomy in management of benign gastric outlet obstruction

Yen-I Chen  1   2 , Theodore W James  3 , Amol Agarwal  1 , Todd H Baron  3 , Takao Itoi  4 , Rastislav Kunda  5 , Jose Nieto  6 , Majidah Bukhari  1 , Olaya Brewer Gutierrez  1 , Omid Sanaei  1 , Robert Moran  1 , Lea Fayad  1 , Mouen A Khashab  1
Affiliations

EUS-guided gastroenterostomy in management of benign gastric outlet obstruction

Yen-I Chen et al. Endosc Int Open. 2018 Mar.

Erratum in

Abstract

Background and study aims: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) in malignant gastric outlet obstruction (GOO) appears to be promising; however, its role in benign GOO is unclear. The aim of this study was to ascertain the clinical efficacy and safety of EUS-GE in benign GOO.

Patients and methods: This was an international retrospective series involving 5 tertiary centers. Consecutive patients who underwent EUS-GE between 1/2013 - 10/2016 for benign GOO were included. The primary endpoint was the rate of clinical success defined as ability to tolerate oral intake without vomiting. Secondary endpoints included technical success and rate of adverse events (AE).

Results: Overall, 26 patients (46.2 % female; mean age 57.7 ± 13.9 years) underwent EUS-GE for benign GOO due to strictures from chronic pancreatitis (n = 11), surgical anastomosis (n = 6), peptic ulcer disease (n = 5), acute pancreatitis (n = 1), superior mesentery artery syndrome (n = 1), caustic injury (n = 1), and hematoma (n = 1). Technical success was achieved in 96.2 %. Dilation of the lumen apposing metal stent was performed in 13/25 (52 %) with a mean maximum diameter of 14.6 ± 1.0 mm. Mean procedure time was 44.6 ± 26.1 min. Clinical success was observed in 84.0 % with a mean time to oral intake of 1.4 ± 1.9 days and a median follow-up of 176.5 (IQR: 47 - 445.75) days. Rate of unplanned re-intervention was 4.8 %. 3 AE were noted including 2 misdeployed stents and 1 gastric leak needing surgical intervention following elective GE stent removal.

Conclusions: EUS-GE is a promising treatment for benign GOO. Larger and prospective data are needed to further validate this novel endoscopic technique in treating benign GOO of various etiologies.

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Conflict of interest statement

Competing interests Yen-I Chen is a consultant for Bostonc Scientific. Todd H. Baron is a consultant and speaker for Boston Scientific and Olympus. Rastislav Kunda is a consultant, speaker, and medical advisory board for Boston Scientific and Omega medical Imaging. Jose Nieto is a consultant for Boston Scientific. Mouen A. Khashab is a consultant for Boston Scientific and Olympus.

Figures

Fig. 1
Fig. 1
Direct EUS-guided gastroenterostomy. a Using a forward-viewing gastroscope, the small bowel is filled with saline mixed with methylene blue and contrast. b Transgastric puncture of the small bowel with a 19-gauge needle. c Aspiration of blue-tinged fluid confirming the proper location of the puncture. d LAMS insertion with cautery assistance and stent deployment as seen on EUS.  e Dilation of the stent with a 15-mm radial expansion balloon. f Endoscopic view of the gastroenterostomy stent post dilation.
Fig. 2
Fig. 2
Clinical outcomes and etiology of gastric outlet obstruction
See this image and copyright information in PMC

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