CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(03): E363-E369
DOI: 10.1055/s-0043-123468
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

EUS-guided gastroenterostomy in management of benign gastric outlet obstruction

Yen-I Chen
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
6  Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montreal, QC, Canada
,
Theodore W. James
2  Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States
,
Amol Agarwal
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Todd H. Baron
2  Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States
,
Takao Itoi
3  Division of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
,
Rastislav Kunda
4  Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
,
Jose Nieto
5  Borland-Groover Clinic, Jacksonville, Florida, United States
,
Majidah Bukhari
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Olaya Brewer Gutierrez
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Omid Sanaei
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Robert Moran
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Lea Fayad
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Mouen A. Khashab
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

submitted 13 September 2017

accepted after revision 14 November 2017

Publication Date:
07 March 2018 (online)

Abstract

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) in malignant gastric outlet obstruction (GOO) appears to be promising; however, its role in benign GOO is unclear. The aim of this study was to ascertain the clinical efficacy and safety of EUS-GE in benign GOO.

Patients and methods This was an international retrospective series involving 5 tertiary centers. Consecutive patients who underwent EUS-GE between 1/2013 – 10/2016 for benign GOO were included. The primary endpoint was the rate of clinical success defined as ability to tolerate oral intake without vomiting. Secondary endpoints included technical success and rate of adverse events (AE).

Results Overall, 26 patients (46.2 % female; mean age 57.7 ± 13.9 years) underwent EUS-GE for benign GOO due to strictures from chronic pancreatitis (n = 11), surgical anastomosis (n = 6), peptic ulcer disease (n = 5), acute pancreatitis (n = 1), superior mesentery artery syndrome (n = 1), caustic injury (n = 1), and hematoma (n = 1). Technical success was achieved in 96.2 %. Dilation of the lumen apposing metal stent was performed in 13/25 (52 %) with a mean maximum diameter of 14.6 ± 1.0 mm. Mean procedure time was 44.6 ± 26.1 min. Clinical success was observed in 84.0 % with a mean time to oral intake of 1.4 ± 1.9 days and a median follow-up of 176.5 (IQR: 47 – 445.75) days. Rate of unplanned re-intervention was 4.8 %. 3 AE were noted including 2 misdeployed stents and 1 gastric leak needing surgical intervention following elective GE stent removal.

Conclusions EUS-GE is a promising treatment for benign GOO. Larger and prospective data are needed to further validate this novel endoscopic technique in treating benign GOO of various etiologies.