Abstract
Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with lumen-apposing metal
stents (LAMS) appears to be a promising intervention in management of gastroduodenal
out obstruction (GOO), particularly for patients for whom surgery is high risk or
in a palliative setting. This study aimed to evaluate the technical feasibility, procedure-associated
adverse events (AEs), and clinical outcome of direct “free hand” EUS-GE.
Patients and methods This retrospective two-center study included patients who underwent direct “free hand”
EUS-GE (April 2017 to March 2021) investigating technical success (correctly placed
LAMS), clinical outcome (successful oral nutrition), and management of procedure-associated
AEs. “Free hand” was defined as the use of the electrocautery enhanced stent delivery
system alone without additional guidewire-assistance for EUS-GE creation.
Results Forty-five patients (58 % women/42 % men; mean age 65 years) with malignant (n = 39),
benign (n = 4) or unclear (n = 2) GOO underwent direct “free hand” EUS-GE. The technical
success rate was 98 % (44/45). Of the patients, 95% (42/44) had less vomiting and
increased ability to tolerate oral food intake after the intervention. In one patient,
a second EUS-GE was necessary to achieve sufficient clinical improvement. Procedure-associated
AEs were observed in 24 % (11/45) of cases including stent misplacement (n = 7), leakage
(n = 1), development of a gastrojejunocolic fistula (n = 1), and bleeding (n = 2),
which could be all managed endoscopically.
Conclusions Direct EUS-GE has a favorable risk-benefit profile for patients with GOO, showing
high technical success rates, manageable AEs, and rapid symptom relief.
