Outcomes of Endoscopic Ultrasound-guided Gastroenterostomy Using Lumen-apposing Metal Stent in the Treatment of Malignant and Benign Gastric Outlet Obstruction: A Case Series
DOI:
https://doi.org/10.33192/smj.v76i4.267242Keywords:
EUS-guided gastroenterostomy, lumen-apposing metal stent, gastric outlet obstruction, benign, malignantAbstract
Objective: To study the outcomes of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumenapposing metal stent (LAMS) in patients with benign and malignant gastric outlet obstruction (GOO).
Materials and Methods: This single-center study retrospectively reviewed the medical records of benign and malignant GOO patients who underwent EUS-GE between May 2019 and September 2023. We evaluated the technical success, adverse events related to the techniques used, clinical success, and recurrence and reintervention rates.
Results: A total of twelve patients who underwent three different EUS-GE techniques were included in this study. The first method was the direct over-the-guidewire technique, the second was the wireless-freehand method, and the third was modified endoscopic ultrasound-guided double-balloon occluded gastroenterostomy bypass (M-EPASS). All 3 techniques used preloaded oroenteral catheters in combination. Technical success was achieved in 83.3% (10/12) of patients, and there were 16.6% (2/12) failures due to misdeployment. One (8.3%) severe adverse event occurred resulting in peritonitis during the direct over-the-guidewire method. The second failure, which ensued after use of the wireless-freehand technique, achieved successful stent deployment at the second attempt without any complications. Clinical success was 100% (11/11), and mean follow up was 6.2 months. There was one (9.1 %) incidence of recurrence at 12-month follow up.
Conclusion: EUS-GE is effective in the management of GOO, and the wireless-freehand and M-EPASS techniques in combination with oroenteral catheters should be the technique of choice in term of safety and efficacy.
References
Adler DG, Baron TH. Endoscopic Palliation of Malignant Gastric Outlet Obstruction Using Self-Expanding Metal Stents: Experience in 36 Patients. Am J Gastroenterol. 2002;97(1):72-8.
Troncone E, Fugazza A, Cappello A, Blanco GDV, Monteleone G, Repici A, et al. Malignant gastric outlet obstruction: Which is the best therapeutic option? World J Gastroenterol. 2020;26(16):1847-60.
Miller C, Benchaya JA, Martel M, Barkun A, Wyse JM, Ferri L, et al. EUS-guided gastroenterostomy vs. surgical gastrojejunostomy and enteral stenting for malignant gastric outlet obstruction: a meta-analysis. Endosc Int Open. 2023;11(7):1-13.
Miranda MP, Tyberg A, Poletto D, Toscano E, Gaidhane M, Desai AP, et al. EUS-guided Gastrojejunostomy Versus Laparoscopic Gastrojejunostomy An International Collaborative Study. J Clin Gastroenterol. 2017;5:896-9.
Bomman S, Ghafoor A, Sanders D, Jayaraj M, Chandra S, Krishnamoorthi R. Enoscopic ultrasound-guided gastroenterostomy versus surgical gastrojejunostomy in treatment of malignant gastric outlet obstruction: Systematic review and meta-analysis. Endosc Int Open. 2022;10:361-8.
Khashab MA, Kumbhari V, Grimm IS, Ngamruengphong S, Aguila G, Zein ME, et al. EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc. 2015;82:932-8.
Tyberg A, Miranda MP, Ocaña RS, Peñas I, Serna C, Shah J, et al. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open. 2016;4:276-81.
On W, Huggett MT, Young A, Pine J, Smith AM, Tehami N, et al. Endoscopic ultrasound guided gastrojejunostomy in the treatment of gastric outlet obstruction: multi-center experience from the United Kingdom. Surg Endosc. 2023;37(3):1749-55.
Tonozuka R, Tsuchiya T, Mukai S, Nagakawa Y and Itoi T. Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction. Clin Endosc. 2020;53:510-8.
Stefanovic S, Draganov PV, Yang D. Endoscopic ultrasound guided gastrojejunostomy for gastric outlet obstruction. World J Gastrointest Surg. 2021;13(7):620-32.
Monino L, Robles E, Gonzalez JM, Snauwaert C, Alric H, Gasmi M, et al. Endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stents: a retrospective multicentric comparison of wireless and over-the wire technique. Endoscopy. 2023;55: 991-99.
Chen YI, Kunda R, Storm AC, Aridi HD, Thomson CC, Neito J, et al. EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques. Gastrointest Endosc. 2018;87:1215-21.
Park KH, Rosas US, Liu QY, Jamil LH, Gupta K, Gaddam S, et al. Safety of teaching endoscopic ultrasound-guided gastro-enterostomy (EUS-GE) can be improved with standardization of the technique. Endosc Int Open. 2022;10:1088-94.
Nguyen NQ, Hamerski CM, Nett A, Watson RR, Rigopoulos M, Binmoeller KB. Endoscopic ultrasound-guided gastroenterostomy using an oroenteric catheter-assisted technique: a retrospective analysis. Endoscopy. 2021;53:1246-9.
Sobani ZA, Paleti S, Rustagi T. Endoscopic ultrasound-guided gastroenterostomy using large-diameter (20 mm) lumen apposing metal stent (LLAMS). Endosc Int Open. 2021; 09:895-900.
Itoi T, Baron TH, Khashab MA, Tsuchiya T, Irani S, Dhir V, et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc. 2017;29(4):495-502.
Itoi T, Ishii K, Ikeuchi N, Sofuni A, Gotoda T, Moriyasu F, et al. Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction. Gut 2016;65(2):193-5.
Basha J, Lakhtakia S, Yariagadda R, Nabi Z, Gupta R, Ramchandani M, et al. Gastric outlet obstruction with ascites: EUS-guided gastro-enterostomy is feasible. Endosc Int Open. 2021;9(12):E1918-23.
Marino A, Bessissow A, Miller C, Valenti D, Boucher L, Chaudhury P, et al. Modified endoscopic ultrasound-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS): a pilot study. Endoscopy. 2022;54:170-2.
Pavert YL, Moons LMG, Bogte A, Vleggaar FP. Innovations in the Treatment of Gastric Outlet Obstruction: Is this the Era of Enodscopic Ultrasonography-Guided Gastroenterostomy? Curr Treat Options Gastro 2023. DOI 10.1007/s11938-023-00417-1.
Bejjani M, Ghandour B, Subtil JC, Moreno BM, Sharaiha RZ, Watson RR, et al. Clinical and technical outcomes of patients undergoing endoscopic ultrasound-guided gastroenterostomy using 20-mm vs. 15-mm lumen-apposing metal stents. Endoscopy. 2022;54:680-7.
Chen YI, James TW, Agarwal A, Baron TH, Itoi T, Kunda R, et al. EUS-guided gastroenterostomy in management of benogn gastric outlet obstruction. Endosc Int Open. 2018;6(3):E363-8.
James TW, Greenberg S, Grimm IS, Baron TH. EUS-guided gastroenteric anastomosis as a bridge to definitive treatment in benign gastric outlet obstruction. Gastroentest Endosc. 2020;91(3):537-42.
Magahis PT, Salgado S, Westerveld D, Dawod E, Carr-locke DL, Sampath K, et al. Prefered techniques for endoscopic ultrasound-guided gastroenterostomy: a survey of expert endosonographer. Endosc Int Open. 2023;11:E1035-45.
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