Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience

Gutierrez, Olaya I. Brewer; Irani, Shayan; Ngamruengphong, Saowanee; Aridi, Hanaa Dakour; Kunda, Rastislav; Siddiqui, Ali A.; Dollhopf, Markus; Nieto, José; Chen, Yen I.; Sahar, Nadav; Bukhari, Majidah; Sanaei, Omid; Canto, Marcia I.; Singh, Vikesh K.; Kozarek, Richard A.; Khashab, Mouen A.

doi:10.1055/s-0044-102254

Cited by 45 publications

(63 citation statements)

References 11 publications

(15 reference statements)

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“…[14,19] It has also been utilized in the management of afferent loop syndrome (ALS) and in the reversal of altered anatomy in patients with previous gastric bypass. [35][36][37][38] In a case series of 15 patients with altered anatomy EUS-GE was technically and clinically successful in all patients with complications reported in only two patients. [38] In a multicenter retrospective series of 18 patients with ALS EUS-GE was technically successful in 100% of the patients.…”

Section: Discussionmentioning

confidence: 94%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 94%

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

et al. 2020

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“…Afferent limb syndrome is usually caused by mechanical obstruction of the afferent limb or kinking. Complete obstruction occurs which leads to cholangitis, pancreatitis, perforation, and necrosis (2).…”

Section: Afferent Loop Syndromementioning

confidence: 99%

“…Dilation of the of the tract is preformed using a balloon catheter or a cystatome over a guidewire which is followed by LAMS deployment. Regardless of the technique used the afferent limb is distended using a mixed solution of contrast saline and methylene blue (2).…”

Section: Afferent Loop Syndromementioning

confidence: 99%

“…The use of EUS-GJ in treatment of afferent limb syndrome has been described in few case reports and small case series (2,13). Recently a multicenter international experience on 18 patients has been published.…”

Section: Afferent Loop Syndromementioning

confidence: 99%

“…For the most part, EUS-GJ has been employed in the treatment of benign and malignant gastric outlet obstruction (GOO) (1). Additionally, EUS-GJ has been used in the treatment of afferent loop syndrome (2).…”

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Endoscopic ultrasound guided gastrojejunostomy

Dawod¹,

Nieto²

2018

Transl. Gastroenterol. Hepatol

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Endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) has been mostly employed in the treatment of benign and malignant gastric outlet obstruction (GOO). Additionally, EUS-GJ has been used in the treatment of afferent loop syndrome. EUS-GJ has been employed in the treatment of benign and malignant GOO. EUS-GJ has also been used in the treatment of afferent loop syndrome. EUS-GJ involves obtaining access to the jejunum endoscopically and sonographically from the stomach, using a biflanged lumen apposing metal stent (LAMS). This is achieved through a newly formed fistulous tract. Thus creating a gastrojejunal bypass fully endoscopically. Several techniques have been described in preforming EUS-GJ but no method has been shown to be superior. In afferent loop syndrome initial data show high technical and clinical success rates and decreased need for reintervention. With malignant GOO, data available from the limited number of studies conducted demonstrated he superiority of EUS-GJ when compared to standard enteral stenting in terms of decreasing recurrence of GOO and need for reintervention. With benign GOO, EUS-GE offers a solution to the long-term patency and recurrence issue encountered with enteral stenting and endoscopic balloon dilation. EUS-GJ offers a less invasive approach than surgery for the treatment of several etiologies, giving the patients the option to avoid adverse events associated with surgery.

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Nasojejunal tube‐assisted endoscopic ultrasound‐guided gastrojejunostomy for the management of gastric outlet obstruction is safe and effective

et al. 2023

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Background and aims Endoscopic ultrasound‐guided gastrojejunostomy (EUS‐GJ) is a therapeutic option for patients with gastric outlet obstruction (GOO), which provides long‐term luminal patency without the risk of tumor ingrowth and/or overgrowth and avoids surgical morbidity. The goal of this study was to assess technical success, clinical success, and adverse events associated with a nasojejunal tube‐assisted EUS‐ GJ technique. Methods This was a retrospective study conducted at a single tertiary care center. The nasojejunal tube (14F) was used to perform the EUS‐GJ (device‐assisted method). During the study period, consecutive GOO patients who underwent EUS‐GJ between August 2018 and December 2021 were included. Technical success was defined as adequate positioning and deployment of the stent. The patient's ability to tolerate a normal oral diet without vomiting was defined as clinical success. Results Thirty patients underwent EUS‐GJ during this study period. Twenty‐six patients had malignant GOO, while four had a benign obstruction. EUS‐GJ was successfully performed in 29 patients, and technical success was 96.67% (29/30). Nasojejunal tube‐assisted EUS‐GJ technique was used in all patients. Clinical success was achieved in all patients who had technical success (29/29, 100%). The adverse events rate was 6.6%. During the procedure, the median procedure time was 25 min (interquartile range 15–42.5), and the average hospitalization was 4.4 days. Normal meals were tolerated by all patients. After 210 days of median follow‐up (range 5–880 days), no recurrence of symptoms was observed. Conclusion The nasojejunal tube‐assisted EUS‐GJ is a safe and effective technique to treat GOO symptoms.

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Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience

Abstract: EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.

Cited by 45 publications

References 11 publications

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

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

Endoscopic ultrasound guided gastrojejunostomy

Nasojejunal tube‐assisted endoscopic ultrasound‐guided gastrojejunostomy for the management of gastric outlet obstruction is safe and effective

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