EUS-guided gastroenterostomy for the management of gastric outlet obstruction: A systematic review and meta-analysis

Abstract

Gastric outlet obstruction (GOO) is a potential complication of pancreatic or distal gastric malignancy and may present in as many as 15%-20% of patients with pancreatic adenocarcinoma. [1,2] Ampullary cancer, lymphoma, and biliary malignancy may also cause GOO. There are also several benign etiologies of GOO including chronic pancreatitis, peptic ulcer ABSTRACT Gastric outlet obstruction (GOO) is characterized by epigastric pain and postprandial vomiting secondary to mechanical obstruction. Management of GOO is usually focused on alleviating the symptoms of obstruction and can be achieved by surgical gastrojejunostomy or enteral stenting. Recent studies have shown success with EUS-guided gastroenterostomy (EUS-GE) in the management of GOO but data is limited. We, therefore, conducted a meta-analysis to evaluate the safety and efficacy of EUS-GE in the management of GOO. A comprehensive literature review was conducted by searching the Embase and PubMed databases from inception to January 2019 to identify all studies that evaluate the efficacy and safety of EUS-GE in GOO. Our primary outcome was to evaluate technical success and clinical success. Secondary outcomes were to evaluate the need for reintervention and adverse events of the procedure. Twelve studies including 285 patients were included in the meta-analysis. Technical success was achieved in 266 patients with a pooled technical success of 92% (95% confidence interval [CI]: 88%-95%). Clinical success was achieved in 90% of the patients (95% CI: 85%-94%). Recurrence of symptoms or unplanned reintervention was needed in 9% of the patients (95% CI: 6%-13%) and adverse events were reported in 12% of the patients (95% CI: 8%-16%). The heterogeneity tests among studies were nonsignificant with I 2 = 0. EUS-GE is a safe and efficacious treatment modality for the management of benign and malignant GOO. Larger prospective studies are needed to further evaluate its utility in GOO.

Long-term placement of lumen-apposing metal stent after endoscopic ultrasound-guided duodeno- and jejunojejunal anastomosis for direct access to excluded jejunal limb

“…agement of gastric outlet obstruction, and biliary access in altered anatomy [9]. LAMS removal after GI anastomosis creation is nowadays the standard of care owing to fear of long-term adverse events (i. e. erosions, migration with risk of leak and/or perforation, bleeding, and buried stent).…”

Endosonografie in der Allgemein- und Viszeralchirurgie

“…Darüber hinaus eröffnet die Endosonografie einen bioptischen Zugang zum Mediastinum, einer anatomischen Region, die mit anderen bildgebenden Verfahren nur schwer erreichbar ist. [22,23]. Die chirurgische Anlage einer Gastrojejunostomie ist vorzuziehen, da nur so eine hintere Gastroenteroanastomose mit besserer Funktionalität angelegt werden kann.…”

Early Lumen-Apposing Metal Stent Dysfunction Complicating Endoscopic Ultrasound-Guided Gastroenterostomy: A Report of Two Cases

“…1 Endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing metal stent (LAMS) is a novel investigational technique, that seems to overcome the shortcomings of the current standard treatments. 2 It is minimally invasive, and the risk of stent dysfunction due to migration or tumor ingrowth is considered to be low because of the features of the LAMS (bi-flanged, short in length, fully covered, and positioned away from the tumoral area). 3 Here, we report two cases with early LAMS dysfunction after EUS-GE had been performed.…”