EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: results from a nationwide multicenter retrospective study (with video)

Sánchez-Aldehuelo, Rubén; Iñigo, José Carlos Subtil; Moreno, Belén Martínez; Gornals, Joan B.; Guarner–Argente, Carlos; Ortega, Alejandro; Herce, Sandra Peralta; Aparicio, José Ramón; Santiago, Enrique Rodríguez de; Bazaga, S; Juzgado, Diego; González-Panizo, Fernando; Albillos, Agustı́n; Vázquez-Sequeiros, Enrique

doi:10.1016/j.gie.2022.07.018

Cited by 21 publications

(16 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also excluded those that did not specify the techniques used or if there were mixed EUS-GE techniques in the pool of patients. A total of 20 studies fulfilled our inclusion criteria: 12 case series and eight comparative studies [12,14,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40].…”

Section: Resultsmentioning

confidence: 99%

“…All studies reported clinical success [12,14,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Clinical success rates were 90.6% for DGE and 88.9% for BTGE (Table 6) with an RD of -0.007 (95% CI -0.06 to 0.046 I2=0% p=0.798) without statistical difference between the groups (Figure 3).…”

Section: Clinical Successmentioning

confidence: 96%

“…Nineteen studies reported severe AEs [12,14,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. The rate was 3.4% and 8.2% for DGE and BTGE (Table 6), respectively.…”

Section: Severe Adverse Eventsmentioning

confidence: 99%

“…All studies [12,14,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] were included in this analysis. The technical success was 94.8% in the direct puncture group and 93.6% in the balloon-assisted group (Table 6), with an RD of -0.012 (95% CI -0.055 to 0.031 I2= 0% p=0.585) without statistical difference between the groups (Figure 2).…”

Section: Technical Successmentioning

confidence: 99%

See 3 more Smart Citations

Endoscopic Ultrasound-Guided Gastroenterostomy for the Palliation of Gastric Outlet Obstruction (GOO): A Systematic Review and Meta-analysis of the Different Techniques

Ribas¹,

Proença²,

Júnior³

et al. 2022

Cureus

View full text Add to dashboard Cite

Introduction: Gastric outlet obstruction (GOO) is usually associated with a poor prognosis and a significant decrease in a patient's quality of life. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMS) has emerged as a safe and effective palliation procedure for GOO in patients that are unfit for surgery. Without an exclusive gold-standard technique for EUS-GE, we aimed to compare the currently available ones in this systematic review and meta-analysis, the first on this subspecialty.Methods: A comprehensive search from multiple electronic databases was performed. The search had a particular emphasis on the techniques used in performing EUS-GE. We identified all the studies in which EUS-GE was performed as palliation for GOO from its inception to the current date. The outcomes analyzed were the following: technical and clinical success, total and severe adverse events (AEs), procedure duration, and length of hospital stay (LOHS).Results: Twenty studies involving 863 patients were the basis of this statistical analysis. Patients underwent the following techniques: direct gastroenterostomy (DGE) (n=718), balloon-assisted gastroenterostomy (BAGE) (n=27), and endoscopic ultrasound (EUS)-guided double-balloon-occluded gastrojejunostomy bypass (n=118). In comparison to balloon-assisted techniques, DGE had a lower rate of AEs, -0.121 (95% CI -0.191 to -0.051 p=0.001); and LOHS for the DGE group, -2.684 (95% CI -1.031 to -4.337 p=0.001). The other analyzed outcomes presented no statistically significant differences. On a sub-analysis, BAGE showed a lower rate of AEs than EUS-guided double-balloon-occluded gastrojejunostomy bypass, -0.196 (95% CI -0.061 to -0.331 p=0.004).Conclusions: EUS-GE is a safe and effective procedure for palliating GOO. When correctly administered, any of the analyzed techniques may be used to palliate GOO with similar technical and clinical outcomes. DGE had significantly lower rates of AEs and LOHS, which can be inferred as a safer procedure. These results should be interpreted cautiously due to the limited few studies that are available and accessible. Therefore, further well-designed, randomized clinical studies on the topic are warranted to compare the different techniques from more sources.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Clinical Successmentioning

confidence: 96%

“…Nineteen studies reported severe AEs [12,14,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. The rate was 3.4% and 8.2% for DGE and BTGE (Table 6), respectively.…”

Section: Severe Adverse Eventsmentioning

confidence: 99%

Section: Technical Successmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic Ultrasound-Guided Gastroenterostomy for the Palliation of Gastric Outlet Obstruction (GOO): A Systematic Review and Meta-analysis of the Different Techniques

Ribas¹,

Proença²,

Júnior³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…Notably, the median elapsed time between the symptoms and the EUS-GE was short in both groups (4 and 6 days). A recent multicenter retrospective study including 97 patients comparing EUS-GE and ES concluded that EUS-GE seems to have improved patency outcomes for palliative treatment of malignant GOO [ 23 ]. In our series, although the baseline GOOSS was also comparable, the GOOSS improvement at 48 h was higher in patients with a duodenal stent.…”

Section: Discussionmentioning

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

Cancers

View full text Add to dashboard Cite

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.

show abstract

Adverse events with endoscopic ultrasound‐guided gastroenterostomy for gastric outlet obstruction—A systematic review and meta‐analysis

Giri,

Harindranath,

Mohan

et al. 2024

UEG Journal

View full text Add to dashboard Cite

BackgroundThe technical and clinical effectiveness of endoscopic ultrasonography (EUS)‐guided gastroenterostomy (GE) has been reported by several meta‐analyses, but few of them have addressed the adverse events (AE). The goal of the current meta‐analysis was to analyze the AEs associated with various types of EUS‐GE.MethodsAll relevant studies reporting the AEs with EUS‐GE were searched from 2000 to 31st March 2023 in MEDLINE, Embase, and Scopus. The event rates were pooled using a random effects model.ResultsA total of 36 studies (n = 1846) were included in the meta‐analysis. The present meta‐analysis reports a pooled technical success rate of 96.9% (95.9–98.0; I2 = 29.3%) with a pooled clinical success rate of 90.6% (88.5–92.7; I2 = 60.9%). The pooled incidence of overall AEs with EUS‐GE was 13.0% (10.3–15.7; I2 = 69.7%), with the commonest being maldeployment of the stent, seen in 4.6% (3.2–6.0; I2 = 50.6%). The pooled incidences of serious AE and procedure‐related mortality were 1.2% (0.7–1.8; I2 = 1.9%) and 0.3% (0.0–0.7; I2 = 0.0%), respectively. Subgroup analysis of studies using only the free‐hand technique showed a significantly lower overall AE and maldeployment but not serious AE and other individual AEs. The pooled incidences of delayed stent migration and stent occlusion were 0.5% (0.0–1.1; I2 = 0.0%) and 0.8% (0.2–1.3; I2 = 0.0%), respectively.ConclusionDespite a technical and clinical success rate of >90%, AEs are seen in around one‐seventh of the cases of EUS‐GE, maldeployment being the commonest. However, the pooled incidence of serious AE and mortality remains low, which is reassuring.

show abstract

EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: results from a nationwide multicenter retrospective study (with video)

Cited by 21 publications

References 30 publications

Endoscopic Ultrasound-Guided Gastroenterostomy for the Palliation of Gastric Outlet Obstruction (GOO): A Systematic Review and Meta-analysis of the Different Techniques

Endoscopic Ultrasound-Guided Gastroenterostomy for the Palliation of Gastric Outlet Obstruction (GOO): A Systematic Review and Meta-analysis of the Different Techniques

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

Adverse events with endoscopic ultrasound‐guided gastroenterostomy for gastric outlet obstruction—A systematic review and meta‐analysis

Contact Info

Product

Resources

About