Endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stents: a retrospective multicentric comparison of wireless and over-the-wire techniques

Abstract

Background Endoscopic ultrasound guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMS) appears to be effective and safe in gastric outlet obstruction (GOO). However, the EUS-GE procedure is not standardized. The use of assisted or direct methods is still debated. The aim of this study was to compare the outcomes of EUS-GE techniques with focus on assisted with a oro-intestinal drain wireless endoscopic simplified technique (WEST) and the non-assisted direct technique over a guidewire (DTOG). Patients This is a multicenter European retrospective study including four tertiary centers. Consecutive patients who underwent EUS-GE between August 2017 and May 2022 for GOO were included. The primary aim was to compare the technical success and adverse event (AE) rates of the different EUS-GE techniques. Clinical success was also analyzed Results A total of 71 patients (66.2±10 years, 42.3% male, 80.3% malignant etiology) were included. Technical success was higher in the WEST group (95.1% vs. 73.3%, eRR:3.2; 95%CI [0.94; 10.9], p=0.014). The rate of AEs was lower in the WEST group (14.6% vs. 46.7%, eRR 2.3; 95%CI [1.2;4.5], p=0.007). The clinical success was comparable in the two groups at one month (97.5% vs. 89.3%). The median follow-up was 5 months (range 1-57). Conclusion The WEST has a higher technical success and less AEs, with a clinical success comparable to the DTOG. Therefore, the WEST technique (with an oro-intestinal drain) should be preferred to perform EUS-GE.

The Role of Luminal Apposing Metal Stents on the Treatment of Malignant and Benign Gastric Outlet Obstruction

“…The only difference was the procedural time, which was significantly longer for the EPASS versus the direct technique (89.9 ± 33.3 vs. 35.7 ± 32.1 min; p < 0.001) [21]. In another recent retrospective multicentric European study [22], the wireless endoscopic simplified technique (WEST) with an orointestinal drain was compared with the nonassisted direct technique over a guidewire (DTOG) in 71 patients (80% with GOO of malignant etiology). Technical success and clinical success rates at 1 month post-procedure were higher in the WEST group (95.1% vs. 73.3%, p = 0.01; 97.5% vs. 89.3%, p = ns.).…”

Revealing Insights: A Comprehensive Overview of Gastric Outlet Obstruction Management, with Special Emphasis on EUS-Guided Gastroenterostomy

“…The first four are the most frequently used [2,9]. Here, we describe the basic steps of each procedure [2,15,16]. The selection of the target site depends on the proximity of the specific segment of the small bowel to the gastric wall, as well as the presence of tumor involvement in the third part of the duodenum.…”

Endoscopic ultrasound-guided gastroenterostomy to treat obstructive gastric twist after laparoscopic sleeve gastrectomy

“…In case of failure, a surgical conversion to Roux-en-Y gastric bypass (RYGB) is performed. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using an oroenteric catheter is a new approach to treat a benign gastric outlet obstruction (GOO) 4 5 . We report the case of a patient with a gastric twist after laparoscopic sleeve gastrectomy successfully treated with EUS-GE after failure of repeat endoscopic dilatation.…”