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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(05): E670-E678
DOI: 10.1055/a-1797-9318
Original article

Efficacy and safety of endoscopic ultrasound-guided gastrojejunostomy in patients with malignant gastric outlet obstruction and ascites

Tala Mahmoud
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Andrew C. Storm
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Ryan J. Law
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Veeravich Jaruvongvanich
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Rabih Ghazi
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Rami Abusaleh
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Eric J. Vargas
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Fateh Bazerbachi
2   Interventional Endoscopy Program, CentraCare Digestive Center, St. Cloud Hospital, St. Cloud, Minnesota, United States
,
Michael J. Levy
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Mark J. Truty
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Vinay Chandrasekhara
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Barham K. Abu Dayyeh
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Background and study aims Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is an endoscopic procedure for treating gastric outlet obstruction (GOO). Limited data exist regarding the safety and efficacy of EUS-GJ in patients with malignant GOO with ascites. Thus, we aimed to study the outcomes and safety of EUS-GJ in GOO patients with vs. without ascites.

Patients and methods This is a retrospective cohort study of patients with malignant GOO who underwent successful EUS-GJ at a tertiary care academic center. Primary outcomes included the efficacy and safety of EUS-GJ. Secondary outcomes included 30-day readmission, reintervention, and survival utilizing Kaplan-Meier analysis.

Results A total of 55 patients (mean age of 67.0 ± 11.3 years, 40.0 % female) who underwent EUS-GJ, of whom 24 had ascites (small in 22, large in 2) were included. Clinical success was achieved in 91.7 % and 93.5 % (P = 1.00) of patients with and without ascites, respectively. A higher rate of adverse events (AEs) was noted in patients with ascites but this was not statistically significant (37.5 % vs. 19.4 %, P = 0.13). Four patients in the ascites group (16.6 %) developed clinical evidence of peritonitis or sepsis post-EUS-GJ. Eight patients with ascites developed worsening ascites within a month of EUS-GJ. In contrast, only one patient without ascites developed evidence of new ascites. The median survival of patients was not significantly different between the two groups (patients with ascites: 129 days vs. patients without ascites: 180 days, (P = 0.12).

Conclusions The efficacy EUS-GJ in the presence of ascites is promising; however, the safety profile remains concerning given the high rate of AEs, specifically peritonitis and sepsis.



Publikationsverlauf

Eingereicht: 19. Oktober 2021

Angenommen nach Revision: 22. Februar 2022

Artikel online veröffentlicht:
13. Mai 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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