Morbidity-Associated Factors after Gastrojejunostomy for Malignant Gastric Outlet Obstruction

Medina‐Franco, Heriberto; Abarca‐Pérez, Leonardo; España-Gómez, Nayví; Salgado‐Nesme, Noel; Ortiz-López, Laura J.; García-Álvarez, Miriam N.

doi:10.1177/000313480707300908

Cited by 18 publications

(7 citation statements)

References 24 publications

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“…Surgical gastrojejunostomy is the preferred treatment for gastric outlet obstruction (GOO), but it carries a complication risk of up to 40 % 1 . Endoscopic placement of an enteral self-expanding metal stent (SEMS) is an alternative treatment option, with technical success rates between 90 % and 100 % and clinical success rates between 67 % and 100 %.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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

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Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…Open surgical gastrojejunostomy has been used for palliation in these patients but carries a higher surgical risk and longer hospital stay, although the bypass tends to remain open longer with fewer reinterventions. Laparoscopic gastrojejunostomy is minimally invasive but still requires general anaesthesia and carries surgical risks in this fragile group of patients [ 50 ].…”

Section: Gastroduodenal Stentingmentioning

confidence: 99%

CIRSE Standards of Practice on Oesophageal and Gastroduodenal Stenting

Diamantopoulos

Choudhury

Irani

et al. 2023

Cardiovasc Intervent Radiol

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Background Image-guided insertion of stents in the upper gastrointestinal trunk is an effective, minimally invasive treatment option to provide immediate relief of symptoms caused by upper gastrointestinal tract obstruction related to advanced-stage malignant causes or benign causes that lead to lumen narrowing. Purpose This document, as with all CIRSE Standards of Practice documents, is not intended to impose a standard of clinical patient care but will recommend a reasonable approach to best practices for performing stenting of the upper gastrointestinal tract, namely the oesophageal and gastroduodenal segments. Our purpose is to provide up-to-date recommendations for placement of upper gastrointestinal tract stents based on the previously published guidelines on this topic in 2005 and 2007. Methods The writing group was established by the CIRSE Standards of Practice Committee and consisted of a group of internationally recognised experts in performing upper gastrointestinal stenting. The writing group reviewed the existing literature using PubMed to search for relevant publications in the English language up to September 2021. The final recommendations were formulated through consensus. Conclusion Insertion of stents in the oesophageal and gastroduodenal tracts has an established role in the successful management of malignant or benign obstructions. This Standards of Practice document provides up-to-date recommendations for the safe performance of upper gastrointestinal stent placement.

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“…Among off-label indications, indeed, GEA seems very promising, probably due to the weakness of the currently available treatment of gastric outlet obstruction, as surgery is burdened by high rate of adverse events and mortality and endoscopic stenting is characterized by a variable rate of clinical success (65%–100%) and rate of reintervention at 6 months up to 60%. [ 31 32 33 ]…”

Section: Discussionmentioning

confidence: 99%

Lumen-apposing metal stents: How far are we from standardization? An Italian survey

et al. 2022

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Background and Objectives: EUS-guided transluminal drainage has increasingly developed, especially after the era of lumen-apposing metal stent (LAMS): a fully covered, barbell-shaped, metal stent with anti-migratory properties allowing direct therapeutic interventions through a wide and short channel. The aim of this survey is to investigate the current management of patients undergoing LAMS placement nationwide. Materials and Methods: Forty-eight questions were submitted to Italian centers about expertise, peri- and intra-procedural aspects, budget/refund, and future perspectives. Statistical analyzer was SPSS®. Results: Thirty-six centers completed the survey. Indications for LAMS positioning are pancreatic fluid collection drainage (PFCD, 97.2%), biliary drainage (BD, 80.5%), gallbladder drainage (GBD, 75%), and gastroentero-anastomosis (GEA, 19.4%). A total of 77.7% of the endoscopists perform only on-label procedures and 22.2% both on-label and off-label. 38.8% attended a training preliminary course, 27.7% were just supported by an expert, 22.2% had both the opportunities, and 8.3% none of them. Management of antiplatelets and sedation protocol is very heterogeneous. Only 50% involves a multidisciplinary meeting and 30.5% has a specialized clinic for follow-up. Acid suppression is usually continued after PFCD. The type and timing of postprocedural imaging varies widely. 8.3% of the endoscopists work without fluoroscopy. Refund for LAMS is mostly not guaranteed. Main future growing indications appear to be BD, GBD, and GEA (69.4%, 55.5%, and 55.5%, respectively). Conclusions: This is the first survey assessing the state of the art on LAMS almost 10 years after their advent. There are currently wide variations in practice nationwide, which demonstrates a pressing need to define technical, qualitative, and peri-procedural requirements to carry out this procedure, toward a standardization.

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Morbidity-Associated Factors after Gastrojejunostomy for Malignant Gastric Outlet Obstruction

Cited by 18 publications

References 24 publications

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

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

CIRSE Standards of Practice on Oesophageal and Gastroduodenal Stenting

Lumen-apposing metal stents: How far are we from standardization? An Italian survey

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