EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction

Ge, Phillip S.; Young, Joyce Y.; Dong, William; Thompson, Christopher C.

doi:10.1007/s00464-018-06636-3

Cited by 169 publications

(168 citation statements)

References 25 publications

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“…▶ In comparative studies where EUS-GE was compared with duodenal stenting, significantly lower rates of GOO symptom recurrence after EUS-GE were found [12,13]. In Ge et al, stent failure requiring repeat intervention occurred in two (8.3 %) LAMS versus 31 (32.0 %) duodenal stent placements (P = 0.021); calculated per stent placed [13]. In Chen et al, GOO recurrence after clinical success occurred in one (4.0 %) EUS-GE patient versus 10 (28.6 %) duodenal stent patients (P = 0.015) [12].…”

Section: Discussionmentioning

confidence: 97%

“…Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) is a novel technique for palliative treatment of malignant GOO. It seems to combine the advantages of duodenal stenting and SGJ, while potentially overcoming their shortcomings [12][13][14][15][16]. EUS-GE is minimally invasive and shows fast relief of symptoms, possibly with lower stent failure and reintervention rates than duodenal stenting [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…It seems to combine the advantages of duodenal stenting and SGJ, while potentially overcoming their shortcomings [12][13][14][15][16]. EUS-GE is minimally invasive and shows fast relief of symptoms, possibly with lower stent failure and reintervention rates than duodenal stenting [12,13]. It also avoids invasive surgery and related morbidity of SGJ, but might provide comparable long-term patency [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

et al. 2020

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Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) is a novel, minimally invasive technique in the palliative treatment of malignant gastric outlet obstruction (GOO). Several studies have demonstrated feasibility and safety of EUS-GE, but evidence on long-term durability is limited. The aim of this study was to evaluate patency of EUS-GE in treatment of malignant GOO. Patients and Methods An international multicenter study was performed in seven centers in four European countries. Patients who underwent EUS-GE with a LAMS between March 2015 and March 2019 for palliative treatment of symptomatic malignant GOO were included retrospectively. Our main outcome was recurrent obstruction due to LAMS dysfunction; other outcomes of interest were technical success, clinical success, adverse events (AEs), and survival. Results A total of 45 patients (mean age 69.9 ± 12.3 years and 48.9 % male) were included. Median duration of follow-up was 59 days (interquartile range [IQR] 41–128). Recurrent obstruction occurred in two patients (6.1 %), after 33 and 283 days of follow-up. Technical success was achieved in 39 patients (86.7 %). Clinical success was achieved in 33 patients (73.3 %). AEs occurred in 12 patients (26.7 %), of which five were fatal. Median overall survival was 57 days (IQR 32–114). Conclusions EUS-GE showed a low rate of recurrent obstruction. The relatively high number of fatal AEs underscores the importance of careful implementation of EUS-GE in clinical practice.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

et al. 2020

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“…Although no mortality has been reported, adverse events such as peritonitis and bleeding have been reported. When compared to enteral stenting, the rates of reintervention for stent dysfunction appears to be lower (6.1% vs 30.3%) for patients undergoing EUS‐guided gastroenteric anastomosis …”

Section: Current Clinical Applicationsmentioning

confidence: 97%

“…When compared to enteral stenting, the rates of reintervention for stent dysfunction appears to be lower (6.1% vs 30.3%) for patients undergoing EUS-guided gastroenteric anastomosis. 22,23 Altered surgical anatomy…”

Section: Gastric Outlet Obstructionmentioning

confidence: 99%

Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

Bang

Varadarajulu

2019

Digestive Endoscopy

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Lumen‐apposing metal stents (LAMS) are integrated in a single‐step delivery platform and can be deployed under endoscopic ultrasound‐guidance for the drainage of intra‐abdominal fluid collections, decompression of obstructed ductal systems, establishment of anastomosis or creation of fistulous tracts between organs that can facilitate further endoscopic interventions if required. A unique feature of LAMS is their ability to approximate the adjoining structures, thereby minimizing the potential for leak and perforation. Consequently, the innovation has advanced our ability to carry out complex therapeutic interventions and obviate the need for high‐risk surgical procedures, particularly in morbid patients. However, a keen awareness of the technical design of LAMS and its implication on treatment effect is important to minimize adverse events and to improve clinical outcomes. This review outlines the technical approach to placement of LAMS, procedural challenges, adverse events, current clinical indications and emerging applications.

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