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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(01): E60-E66
DOI: 10.1055/a-1976-2279
Original article

Endoscopic ultrasound-guided gastroenterostomy for the management of gastric outlet obstruction: A large comparative study with long-term follow-up

Veeravich Jaruvongvanich
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Tala Mahmoud
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
,
Vinay Chandrasekhara
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Ryan Law
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
,
Michael J. Levy
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
,
Neil B. Marya
2   Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts, United States
,
Donna M. Abboud
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
,
Reem Matar
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Babusai Rapaka
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Navtej Buttar
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Mark J. Truty
3   Division of Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Maridi Aerts
4   Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
,
Nouredin Messaoudi
5   Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
,
Rastislav Kunda
6   Department of Surgery, Department of Gastroenterology-Hepatology, Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Abstract

Background and study aims Gastric outlet obstruction (GOO) is traditionally managed with surgical gastroenterostomy (surgical-GE) and enteral stenting (ES). Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is now a third option. Large studies assessing their relative risks and benefits with adequate follow-up are lacking. We conducted a comparative analysis of patients who underwent EUS-GE, ES, or surgical-GE for GOO.

Patients and methods In this retrospective comparative cohort study, consecutive patients presenting with GOO who underwent EUS-GE, ES, or surgical-GE at two academic institutions were reviewed and independently cross-edited to ensure accurate reporting. The primary outcome was need for reintervention. Secondary outcomes were technical and clinical success, length of hospital stay (LOS), and adverse events (AEs).

Results A total of 436 patients (232 EUS-GE, 131 ES, 73 surgical-GE) were included. The median duration of follow-up of the entire cohort was 185.5 days (interquartile range 55.25–454.25 days). The rate of reintervention in the EUS-GE group was lower than in the ES and surgical-GE groups (0.9 %, 12.2 %, and 13.7 %, P < 0.0001). Technical success was achieved in 98.3 %, 99.2 %, and 100 % (P = 0.58), and clinical success was achieved in 98.3 %, 91.6 %, and 90.4 % (P < 0.0001) in the EUS-GE, ES, and surgical-GE groups, respectively. The EUS-GE group had a shorter LOS (2 days vs. 3 days vs. 5 days, P < 0.0001) and a lower AE rate than the ES and surgical-GE groups (8.6 % vs. 38.9 % vs. 27.4 %, P < 0.0001).

Conclusion This large cohort study demonstrates the safety and palliation durability of EUS-GE as an alternative strategy for GOO palliation in select patients.

Supplementary material



Publication History

Received: 16 May 2022

Accepted after revision: 03 November 2022

Accepted Manuscript online:
10 November 2022

Article published online:
13 January 2023

© 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/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2023; 55(03): 299-299
DOI: 10.1055/a-1998-4829

Letter to this article:

EUS Gastroenterostomy: Primetime for All?Endosc Int Open 2023; 11(06): E566-E567
DOI: 10.1055/a-2090-0533

 

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