Endosc Int Open 2016; 04(03): E276-E281
DOI: 10.1055/s-0042-101789
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Amy Tyberg
1   Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
,
Manuel Perez-Miranda
2   Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
,
Ramon Sanchez-Ocaña
2   Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
,
Irene Peñas
2   Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
,
Carlos de la Serna
2   Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
,
Janak Shah
3   Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA
,
Kenneth Binmoeller
3   Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA
,
Monica Gaidhane
1   Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
,
Ian Grimm
4   Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, North Carolina, USA
,
Todd Baron
4   Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, North Carolina, USA
,
Michel Kahaleh
1   Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
› Author Affiliations
Further Information

Publication History

submitted 17 November 2015

accepted after revision 15 December 2015

Publication Date:
18 March 2016 (online)

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

 
  • References

  • 1 Medina-Franco H, Abarca-Pérez L, España-Gómez N et al. Morbidity-associated factors after gastrojejunostomy for malignant gastric outlet obstruction. Am Surg 2007; 73: 871-875
  • 2 Khashab M, Alawad AS, Shin EJ et al. Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 2013; 27: 2068-2075
  • 3 van Hooft JE, Uitdehaag MJ, Bruno MJ et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc 2009; 69: 1059-1066
  • 4 Phillips MS, Gosain S, Bonatti H et al. Enteral stents for malignancy: a report of 46 consecutive cases over 10 years, with critical review of complications. J Gastrointest Surg 2008; 12: 2045-2050
  • 5 Binmoeller KF, Shah JN. Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study. Endoscopy 2012; 44: 499-503
  • 6 Itoi T, Ishii K, Tanaka R et al. Current status and perspective of endoscopic ultrasonography-guided gastrojejunostomy: endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy (with videos). J Hepatobiliary Pancreat Sci 2015; 22: 3-11
  • 7 Luo H, Pan Y, Min L et al. Transgastric endoscopic gastroenterostomy using a partially covered occluder: a canine feasibility study. Endoscopy 2012; 44: 493-498
  • 8 Vanbiervliet G, Bonin EA, Garcès R et al. Gastrojejunal anastomosis using a tissue-apposing stent: a safety and feasibility study in live pigs. Endoscopy 2014; 46: 871-877
  • 9 Barthet M, Binmoeller KF, Vanbiervliet G et al. Natural orifice transluminal endoscopic surgery gastroenterostomy with a biflanged lumen-apposing stent: first clinical experience (with videos). Gastrointest Endosc 2015; 81: 215-218
  • 10 Tyberg A, Kumta N, Karia K et al. EUS-guided gastrojejunostomy after failed enteral stenting. Gastrointest Endosc 2015; 81: 1011-1012
  • 11 Itoi T, Tsuchiya T, Tonozuka R et al. Novel EUS-guided double-balloon-occluded gastrojejunostomy bypass. Gastrointest Endosc 2015; [Epub]
  • 12 Tyberg A, Zerbo S, Barthet M et al. A novel technique for salvaging a dislodged lumen-apposing metal stent during creation of an endoscopic gastrojejunostomy. Gastrointest Endosc 2015; [Epub]
  • 13 Itoi T, Ishii K, Ikeuchi N et al. Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction. Gut 2015; [Epub]
  • 14 Khashab MA, Kumbhari V, Grimm IS et al. EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc In press 2015; DOI: 10.1016/j.gie.2015.06.017.
  • 15 De la Serna-Higuera C, Pérez-Miranda M, Gil-Simón P et al. EUS-guided transenteric gallbladder drainage with a new fistula-forming, lumen-apposing metal stent. Gastrointest Endosc 2013; 77: 303-308