Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience

Abstract

Background: Surgical gastrojejunostomy and enteral self-expanding metal stents are efficacious for the management of gastric outlet obstruction but limited by high complication rates and short-term efficacy. Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is a novel alternative option. Patients and methods: Patients who underwent EUS-GJ between March 2014 and September 2015 as part of a prospective multicenter registry at four academic centers in two countries were included. Technical success was defined as successful placement of a gastrojejunal lumen-apposing metal stent. Clinical success was defined as the ability of the patient to tolerate an oral diet. Post-procedural adverse events were recorded. Results: The study included 26 patients, of whom 11 (42 %) were male. Technical success was achieved in 24 patients (92 %). Clinical success was achieved in 22 patients (85 %). Of the 4 patients in whom clinical success was not achieved, 2 had persistent nausea and vomiting despite a patent EUS-GJ and required enteral feeding for nutrition, 1 died before the initiation of an oral diet, and 1 underwent surgery for suspected perforation. Adverse events, including peritonitis, bleeding, and surgery, occurred in 3 patients (11.5 %). Conclusion: EUS-GJ is an emerging procedure that has efficacy and safety comparable with those of current therapies and should hold a place as a new minimally invasive option for patients with gastric outlet obstruction.Clinical trial identification number: NCT01522573

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

“…98 More recently, 26 patients with GOO-17 due to malignant etiology-were included in a prospective multicenter study utilizing various approaches to EUS-GE with LAMS placement. 101 Technical success was reported in 92% of patients, with symptom resolution in 15 of the 17 patients with malignant GOO. Major post-procedural complications included one patient with severe bleeding and one report of peritonitis.…”

“…Major post-procedural complications included one patient with severe bleeding and one report of peritonitis. 101 Itoi et al 102 performed the innovative EUS-guided double-balloon-occluded bypass using LAMS in 20 patients with GOO due to malignancy. All patients with procedural success (90%) experienced GOO-related symptom improvement.…”

Lumen apposing metal stents: A review of current uses and outcomes

“…37,38 However, SEMS can become obstructed or overgrown by tumor resulting in reduced luminal patency (57% in one study) after 6 months. 39 With the recent development of LAMS, Tyberg et al 40 examined the utility of LAMS for EUS-guided GJ (EUS-GJ) in patients with benign and malignant GOO. In an international, prospective trial of 26 patients with GOO, the authors demonstrated technical success of EUS-GJ using LAMS in 24 patients (92.3%).…”

“…The authors felt that EUS-GJ appears to be a less expensive option than its surgical equivalent. 40 It is not known how LAMS GJ compares to traditional endoscopic treatments for GOO like enteral stents, which do not require transluminal access to work.…”

Advances in endotherapy in chronic pancreatitis

“…More recently, two small studies evaluating the efficacy and safety of EUS-GE have been published including patients with benign or malignant GOO. These studies reported the results of 10 patients 65 and 26 patients, 66 both describing 90% technical success rates, and clinical success rates of 100% and 85%, respectively. 65,66 The rates of adverse events were 0% in the series by Khashab et al 65 and 3% in the larger report by Tyberg et al 66 with one death.…”