Abstract
Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique developed
to manage gastric outlet obstruction (GOO). It involves creating a fistula between
the stomach and the proximal small bowel using an electric cautery-enhanced lumen-apposing
metal stent (ECE-LAMS) with EUS guidance. We aimed to publish our experience in improving
teaching of this technique to practicing endoscopists with a wide range of experience
by comparing the outcomes before and after standardization of procedural steps.
Methods All EUS-GEs performed for inoperable GOO at a single institution from 2014 to 2021
were retrospectively analyzed. The technique was taught by one experienced endoscopist
with prior expertise. Five advanced endoscopists with prior EUS and ECE-LAMS placement
experience participated. The impact of standardization on outcomes (clinical and technical
success, length of stay [LOS], procedure time, and adverse events [AEs]) was compared.
Results A total 41 EUS-GEs were performed (5 before and 36 after standardization) by endoscopists
with practice experience ranging from 2 to 13 years. The patient population was similar
in age and sex. Standardization was associated with significantly higher rates of
technical success (100 % vs 60 %, P = 0.01) and lower peri-procedural AEs (2.8 % vs 40 %, P = 0.03). Two AEs in the pre-standardized group were gastric perforation and gastrocolic
fistula creation. One AE in the post-standardized group was gastric perforation. Procedure
time, clinical success, and LOS showed improvement, although it was not statistically
significant.
Conclusions Teaching EUS-GE after standardizing the procedure was associated with a significant
increase in technical success and a decrease in AEs irrespective of prior total experiences.
