Endoscopic ultrasound guided gastrojejunostomy for gastric outlet obstruction

Abstract

Gastric outlet obstruction (GOO) is a clinical syndrome secondary to luminal obstruction at the level of the stomach and/or duodenum. GOO can be caused by either benign or malignant etiologies, often resulting in early satiety, nausea, vomiting and poor oral intake. GOO is associated with decreased quality of life and has been shown to significantly impact survival in patients with advanced malignancies. Traditional treatment options for GOO can be broadly divided into surgical [surgical gastrojejunostomy (GJ)] and endoscopic interventions (dilation and/or placement of luminal self-expanding metal stents). While surgical GJ has been shown to provide a more lasting relief of symptoms when compared to luminal stenting, it has also been associated with a higher rate of adverse events. Furthermore, many patients with advanced metastatic disease are not good surgical candidates. More recently, endoscopic ultrasound (EUS)-guided GJ has emerged as a potential alternative to traditional surgical and endoscopic approaches. This review focuses on the new advances and technical aspects of EUS-GJ and clinical outcomes in the management of both benign and malignant disease.

Futuristic Developments and Applications in Endoluminal Stenting

“…The rationale of EUS-guided GE is similar to surgical gastro-jejunostomy (SGJ) and consists in identifying the target jejunal loop, followed by the creation of a gastro-jejunal or jejuno-jejunostomy under ultrasonographic and endoscopic visualization. Bi-flanged LAMS, particularly those with electrocautery-enhanced delivery systems, are the most used devices to create the GE anastomosis, and its availability increased the technical feasibility of the procedure [ 104 ]. This procedure is usually performed using a 15 mm diameter LAMS.…”

Endoscopic ultrasound guided gastrojejunostomy in the treatment of gastric outlet obstruction: multi-centre experience from the United Kingdom

“…Although re-intervention is usually straight forward, the need for repeated procedures, symptom recurrence affecting QOL and interruptions in oncological treatment have to be considered. A life expectancy threshold of 3 months has been suggested as a cutoff for considering EUS-GJ or S-GJ over ES [19]. In the present study, 22 patients had malignant GOO and over a median follow-up period of 161 days, re-intervention was only required in 1 patient.…”

Endoscopic ultrasound‐guided balloon‐occluded gastrojejunostomy bypass, duodenal stent or laparoscopic gastrojejunostomy for unresectable malignant gastric outlet obstruction

“…A number of different methods for performing EUS‐GE have been described and these include direct unassisted EUS‐GE with the water irrigation technique, device‐assisted EUS‐GE and EPASS 21 . The procedure is associated with a technical and clinical success rate of 92.9% and 90.1% respectively and a 10.6% adverse event rate 12,22 . Stent misdeployment is the most worrisome adverse event and one patient in the current study suffered from this requiring surgical intervention.…”