EUS-guided Gastrojejunostomy Versus Laparoscopic Gastrojejunostomy

Pérez-Miranda, Manuel; Tyberg, Amy; Poletto, D.J.; Toscano, Ernesto; Gaidhane, Monica; Desai, Amit P.; Kumta, Nikhil A.; Fayad, Lea; Nieto, José; Barthet, Marc; Shah, Raj J.; Brauer, Brian C.; Sharaiha, Reem Z.; Kahaleh, Michel

doi:10.1097/mcg.0000000000000887

Cited by 183 publications

(198 citation statements)

References 12 publications

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“…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%

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: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…1 The development of walled-off necrosis (WON) is a late complication of acute severe necrotizing pancreatitis, and endoscopic necrosectomy (EN) has become an effective treatment for infected WON. A multicenter study [2][3][4] of EN in WON revealed clinical success rates from 75% to 91%. However, high mortality and morbidity rates of 6.7-11% and 14-33%, respectively, were found.…”

Section: Current Problems and Clinical Results Of Endoscopic Necrosecmentioning

confidence: 99%

“…As a new approach, endoscopic ultrasonography-guided gastrojejunostomy (EUS-GJ), which utilizes these advantages, has emerged in the clinical setting. [1][2][3][4] However, EUS-GJ is not always successful because of invisible jejunum under EUS due to air or collapse of the jejunum, leading to mispuncture to the large intestine and misdeployment of the stent. To overcome these problems, we developed the EUS-guided double-balloon-occluded gastrojejunostomy bypass (EPASS).…”

Section: Case Of Successful Endoscopic Ultrasonography-guided Gastrojmentioning

confidence: 99%

Case of successful endoscopic ultrasonography‐guided gastrojejunostomy for gastric outlet obstruction caused by gallbladder carcinoma

Tsuchiya

Sofuni

Itoi

2019

Digestive Endoscopy

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“…A recent international multicentre study that included 26 patients showed a technical and clinical success rate of 92 and 85%, respectively [73]. When compared to laparoscopic GJ, EUS-guided GJ seems to be associated with fewer adverse events and lower costs, as was described by a Spanish group in a comparative study [74]. Further studies comparing this approach with luminal stent placement are warranted.…”

Section: Eus-guided Gastrojejunostomymentioning

confidence: 94%

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

Nunes

Fonseca

Barata

et al. 2019

GE Port J Gastroenterol

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Background: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. Summary: This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care. Conclusions: Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.

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EUS-guided Gastrojejunostomy Versus Laparoscopic Gastrojejunostomy

Abstract: Although the EUS-GJ group contained more complex patients, efficacy was similar between the groups. AEs were significantly lower in the EUS-GJ group. EUS-GJ is a safe and efficacious, minimally invasive option for patients with GOO.

Cited by 183 publications

References 12 publications

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

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

Case of successful endoscopic ultrasonography‐guided gastrojejunostomy for gastric outlet obstruction caused by gallbladder carcinoma

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

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