EUS-guided gastroenterostomy using a novel electrocautery lumen apposing metal stent for treatment of gastric outlet obstruction (with video)

Mangiavillano, Benedetto; Larghi, Alberto; Vargas-Madrigal, Jorge; Facciorusso, Antonio; Matteo, Francesco Di; Crinò, Stefano Francesco; Pham, Khanh Do-Cong; Moon, Jong Hoo; Auriemma, Francesco; Camellini, Lorenzo; Paduano, Danilo; Stigliano, Serena; Calabrese, Federica; Ofosu, Andrew; Al-Lehibi, Abed; Repici, Alessandro

doi:10.1016/j.dld.2023.02.009

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…The Hot-Axios™ (Boston Scientific Corporation, Natick, MA, USA) was the first EC-LAMS released into the market, leading to its widespread adoption. Recently, an EC-LAMS version by Taewoong Medical (Hot-Spaxus; Taewoong Medical Co., Gimpo, Republic of Korea) has been released into the market [48]. Stent deployment occurs through the gradual release of each flange while being visualized endoscopically and endosonographically.…”

Section: Eus-guided Gastroenteric-anastomosismentioning

confidence: 99%

Management of Malignant Gastric Outlet Obstruction: A Comprehensive Review on the Old, the Classic and the Innovative Approaches

Fugazza,

Andreozzi,

Asadzadeh Aghdaei

et al. 2024

Medicina

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Gastrojejunostomy is the principal method of palliation for unresectable malignant gastric outlet obstructions (GOO). Gastrojejunostomy was traditionally performed as a surgical procedure with an open approach butrecently, notable progress in the development of minimally invasive procedures such as laparoscopic gastrojejunostomies have emerged. Additionally, advancements in endoscopic techniques, including endoscopic stenting (ES) and endoscopic ultrasound-guided gastroenterostomy (EUS-GE), are becoming more prominent. ES involves the placement of self-expandable metal stents (SEMS) to restore luminal patency. ES is commonly the first choice for patients deemed unfit for surgery or at high surgical risk. However, although ES leads to rapid improvement of symptoms, it carries limitations like higher stent dysfunction rates and the need for frequent re-interventions. Recently, EUS-GE has emerged as a potential alternative, combining the minimally invasive nature of the endoscopic approach with the long-lasting effects of a gastrojejunostomy. Having reviewed the advantages and disadvantages of these different techniques, this article aims to provide a comprehensive review regarding the management of unresectable malignant GOO.

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Section: Eus-guided Gastroenteric-anastomosismentioning

confidence: 99%

Management of Malignant Gastric Outlet Obstruction: A Comprehensive Review on the Old, the Classic and the Innovative Approaches

Fugazza,

Andreozzi,

Asadzadeh Aghdaei

et al. 2024

Medicina

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“…As described above, different variants of the technique have been developed over the years, changing the devices used for GEA creation or for loop enlargement, or in techniques for the target loop puncture. By the way, EUS-GEA for the treatment of gastric outlet obstruction (GOO) was initially performed only with one type of electrocautery lumen-apposing metal stents (EC-LAMS), especially thanks to the releasing system permitting the easy use of the wireless "free-hand" technique, but the use of another EC-LAMS was recently reported in the creation of a EUS-GEA [84,85], so further comparisons are expected in the near future. In general, therefore, the techniques for EUS-GEA can be summarized as direct EUS-GE, balloon-assisted EUS-GE, EUS-guided double-balloon-occluded gastrojejunostomy bypass (EPASS), and the wireless EUS-guided gastroenterostomy simplified technique (WEST), techniques that are described in-depth in other technical studies [85][86][87][88][89][90].…”

Section: Eus-guided Gastro-entero-anastomosismentioning

confidence: 99%

The Role of Endoscopy in the Palliation of Pancreatico-Biliary Cancers: Biliary Drainage, Management of Gastrointestinal Obstruction, and Role in Relief of Oncologic Pain

Rizzo,

Carrozza,

Rancatore

et al. 2023

Cancers

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Therapeutic endoscopy permits many and various treatments for cancer palliation in patients with bilio-pancreatic cancers, enabling different options, supporting patients during their route to oncologic treatments, and trying to improve their quality of life. Therefore, both endoscopic and endoscopic ultrasound (EUS)-guided techniques are performed in this scenario. We performed a literature review focusing on the role of endoscopy in the palliation of those advanced pancreatic and biliary cancers developing malignant biliary obstruction (MBO), gastric outlet obstruction (GOO), and pain unresponsive to medical therapies. Therefore, we explored and focused on the clinical outcomes of endoscopic procedures in this scenario. In fact, the endoscopic treatment is based on achieving biliary drainage in the case of MBO through endoscopic retrograde cholangiopancreatography (ERCP) or EUS-guided biliary drainage (EUS-BD), while GOO is endoscopically treated through the deployment of an enteral stent or the creation of EUS-guided gastro-entero-anastomosis (EUS-GEA). Furthermore, untreatable chronic abdominal pain is a major issue in patients unresponsive to high doses of painkillers, so EUS-guided celiac plexus neurolysis (CPN) or celiac ganglia neurolysis (CGN) helps to reduce dosage and have better pain control. Therefore, therapeutic endoscopy in the palliative setting is an effective and safe approach for managing most of the clinical manifestations of advanced biliopancreatic tumors.

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“…While initially developed for the management of pancreatic fluid collections (PFC), the electrocautery-enhanced stent with its antimigratory property broadened its offlabel use for managing both luminal and transluminal conditions [2,3]. In particular, the endoscopic ultrasound (EUS)-guided transluminal deployment of LAMS facilitated management of broader gastrointestinal (GI) pathologies such as gastric outlet obstruction (GOO) [4][5][6], drainage of pancreatic and nonpancreatic (intra-abdominal and pelvic) fluid collections [7,8], gallbladder drainage [9], and the management of distal malignant biliary obstruction [10], among others. More recently, LAMS have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions [11,12], because LAMS and its wide lumen design allow the passage of standard endoscopes into the distant parts of the tracts that would have been otherwise hard to access [2].…”

Section: Introductionmentioning

confidence: 99%

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Ichkhanian,

Jovani

2023

Current Opinion in Gastroenterology

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Purpose of review Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions. Recent findings Pancreatobiliary (PB) and non-PB interventions are challenging in patients with SAA. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and endoscopic ultrasound (EUS)-directed transenteric ERCP (EDEE) are effective procedures that are being increasingly utilized to perform ERCP in patient with Roux-en-Y gastric bypass (RYGB) and non-RYGB SAA, respectively. Furthermore, EUS-directed trans-gastric intervention (EDGI) is a collective term for the non-PB procedures that could be performed in patients with SAA. EDGE/EDEE/EDGI are considered relatively safe procedures, however, intra-procedural stent misdeployement, and long-term ramifications of persistent fistula and stent migration could require endoscopic or, in rare instances, surgical management. Summary The advent of LAMS has revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. With the growing body of literature, it is expected that such techniques will be more commonly performed in the community, providing less invasive and more effective treatment options for patients with SAA.

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EUS-guided gastroenterostomy using a novel electrocautery lumen apposing metal stent for treatment of gastric outlet obstruction (with video)

Cited by 5 publications

References 22 publications

Management of Malignant Gastric Outlet Obstruction: A Comprehensive Review on the Old, the Classic and the Innovative Approaches

Management of Malignant Gastric Outlet Obstruction: A Comprehensive Review on the Old, the Classic and the Innovative Approaches

The Role of Endoscopy in the Palliation of Pancreatico-Biliary Cancers: Biliary Drainage, Management of Gastrointestinal Obstruction, and Role in Relief of Oncologic Pain

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

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