Endoscopic ultrasound‐guided gastrointestinal anastomosis: Current status and future perspectives

Bronswijk, Michiel; Pérez-Cuadrado-Robles, Enrique; Merwe, Schalk van der

doi:10.1111/den.14381

Cited by 11 publications

(11 citation statements)

References 51 publications

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“…Endoscopic ultrasound‐guided gastroenterostomy (EUS‐GE) with lumen‐apposing metal stents is a novel method in recent years, although duodenal stenting is the current standard treatment. EUS‐GE showed higher clinical success and lower stent dysfunction rates, with similar safety, compared with duodenal stenting 10 . EUS‐GE has become an alternative to duodenal stenting for malignant GOO in expert centers.…”

mentioning

confidence: 88%

“…EUS-GE showed higher clinical success and lower stent dysfunction rates, with similar safety, compared with duodenal stenting. 10 EUS-GE has become an alternative to duodenal stenting for malignant GOO in expert centers. Randomized controlled trials to confirm the superiority of EUS-GE to duodenal stenting are needed, and improvements of techniques and devices are necessary to conduct EUS-GE in many institutions.…”

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confidence: 99%

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Can large duodenal covered metal stents reduce the risk of stent migration?

Naitoh

Hori

2022

Digestive Endoscopy

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Gastric outlet obstruction (GOO) is commonly caused by advanced-stage gastric or pancreatobiliary neoplasms; it is associated with symptoms that impair quality of life, such as poor oral intake, nausea, and vomiting. Endoscopic selfexpandable metal stent (SEMS) placement is widely accepted for palliative treatment of unresectable malignant GOO because it is less invasive than surgical gastrojejunostomy. Uncovered SEMS and covered SEMS (CSEMS) are available in clinical practice. The main causes of recurrent GOO are tumor ingrowth and stent migration for uncovered SEMS and CSEMS, respectively. [1][2][3] The use of CSEMS can prevent tumor ingrowth via stent mesh, but it increases the risk of stent migration. An antimigration system for CSEMS is expected to prolong the time to recurrent GOO, and improvements of the system have been made. A CSEMS with a large uncovered flare at the proximal end to prevent stent migration could not reduce the rate of stent migration. [3][4][5] The fixation of a SEMS with devices such as an over-the-scope clip (OTSC), endoscopic suturing system, and clips reportedly helps to prevent stent migration. However, simple and safe methods for the prevention of stent migration are desirable to prolong the time to recurrent GOO in the use of CSEMS.In this issue of Digestive Endoscopy, Inokuma et al. 6 evaluated the novel large-bore CSEMS with 24 mm diameter (24 mm CSEMS) by comparison to a conventional CSEMS with 20 mm diameter (20 mm CSEMS). The time to recurrent GOO was significantly longer with the 24 mm CSEMS than with the 20 mm CSEMS (median 380 days vs. 138 days; P = 0.01). Furthermore, multivariate analysis revealed that stent diameter was the only factor with a significant effect on time to recurrent GOO. This study was the first to demonstrate that larger diameter was associated with longer time to recurrent GOO in patients who received CSEMS.Stent migration is a major cause of recurrent GOO in patients with CSEMS; the incidence of stent migration reportedly ranges from 6% to 32%. 7 In the study by Inokuma et al.,6 no symptomatic stent migration was

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confidence: 88%

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confidence: 99%

Can large duodenal covered metal stents reduce the risk of stent migration?

Naitoh

Hori

2022

Digestive Endoscopy

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“…Endoscopic ultrasound‐guided gastroenterostomy (EUS‐GE) is a novel and minimally invasive intervention for the palliation of malignant gastric outlet obstruction 1,2 . Recently, EUS‐GE performed using a novel lumen‐apposing metal stent (LAMS) with a larger diameter and wheel‐shaped flanges yielded excellent outcomes 3 .…”

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confidence: 99%

“…

BRIEF EXPLANATION E NDOSCOPIC ULTRASOUND-GUIDED GASTRO-ENTEROSTOMY (EUS-GE) is a novel and minimally invasive intervention for the palliation of malignant gastric outlet obstruction. 1,2 Recently, EUS-GE performed using a novel lumen-apposing metal stent (LAMS) with a larger diameter and wheel-shaped flanges yielded excellent outcomes. 3 We present the case of a patient with

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confidence: 99%

Challenging method of endoscopic ultrasound‐guided gastroenterostomy using a novel electrocautery‐enhanced lumen‐apposing metal stent for afferent and efferent loop obstruction

Lee

Park

2022

Digestive Endoscopy

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“…Endoscopic ultrasound (EUS)-guided therapies are gaining ground in the armamentarium of interventional endoscopy [ 1 ]. The creation of digestive anastomosis by using lumen apposing metal stents (LAMS) has greatly impacted the decision-making strategy in selected patients with altered anatomy (e.g., gastric bypass, afferent limb syndrome) [ 2 , 3 ], difficult biliary drainage [ 4 ], and gastric outlet obstruction (GOO) [ 5 ]. EUS-guided gastroenterostomy (EUS-GE) [ 6 ], in particular, has been proposed as an alternative in the treatment of malignant GOO and will probably be the mainstay in the management of this disease in the near future.…”

Section: Introductionmentioning

confidence: 99%

EUS-Guided Gastroenterostomy in Malignant Gastric Outlet Obstruction: A Comparative Study between First- and Second-Line Approaches after Enteral Stent Placement

Pérez-Cuadrado-Robles

Alric

Aidibi

et al. 2022

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Introduction: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly used in the setting of malignant gastric outlet obstruction (GOO). However, little is known about the role of primary EUS-GE. The aim of the present study is to compare the outcomes of EUS-GE by using the freehand technique as a first- and second-line approach after enteral stenting (ES). Methods: This is an observational single-center study using a prospectively collected database. All consecutive patients who underwent an EUS-GE using the freehand technique due to malignant GOO were included. Patients with previous gastric surgery, a wire-guided EUS-GE technique, or those presenting without GOO were excluded. The primary outcome was the clinical success, defined as a solid oral intake at 1 week after the procedure (GOO Score, GOOSS ≥ 2). The secondary outcomes were technical success and adverse event (AE) rates. The impact on nutritional parameters was also assessed. Results: Forty-five patients underwent an EUS-GE for all indications. Finally, 28 patients (mean age: 63 ± 17.2 years, 57.1% male) with (n = 13, 46.4%) and without (n = 15, 53.6%) a previous ES were included. The technical success was achieved in 25 cases (89.3%), with no differences between the two groups (92.3% vs. 86.7%, p = 1). The median limb diameter and procedure time were 27 mm (range:15–48) and 37 min. Overall, clinical success was achieved in 22 cases (88%), with three failures due to AEs (n = 2) or peritoneal carcinomatosis (n = 1). The diet progression was quicker in patients with a previous ES (GOOSS at 48 h, 2 vs. 1, p = 0.023), but the GOOSS at 1 week (p = 0.299), albumin gain (p = 0.366), and BMI gain (0.257) were comparable in the two groups. The AE rate was 7.1%. Conclusions: EUS-GE achieves a high technical and clinical success in patients with GOO regardless of the presence of a previous ES. Patients with previous ES may have a quicker progression of their diet, but the GOOSS and nutritional status in the long term at 1 week or 1 month are comparable. Primary EUS-GE might require fewer procedures and less discontinuation of chemotherapy to achieve a comparable result.

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Endoscopic ultrasound‐guided gastrointestinal anastomosis: Current status and future perspectives

Cited by 11 publications

References 51 publications

Can large duodenal covered metal stents reduce the risk of stent migration?

Can large duodenal covered metal stents reduce the risk of stent migration?

Challenging method of endoscopic ultrasound‐guided gastroenterostomy using a novel electrocautery‐enhanced lumen‐apposing metal stent for afferent and efferent loop obstruction

EUS-Guided Gastroenterostomy in Malignant Gastric Outlet Obstruction: A Comparative Study between First- and Second-Line Approaches after Enteral Stent Placement

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