EUS-Guided Gastroenterostomy As Treatment Of Benign Gastric Outlet Obstruction

Aims The role of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) in benign gastric outlet obstruction (GOO) remains unclear. We aimed at evaluating the clinical efficacy and safety of EUS-GE in benign GOO.

Methods Case series including consecutive patients presenting with benign GOO who underwent EUS-GE between November 2017 and January 2020 at a single tertiary care center. Demographics, procedural details, post-procedure follow-up and outcome measures were retrospectively retrieved.

Results A total of 13 patients, 8 (61.5 %) males, median age: 63.8 years (IQR: 50.8-81.9) were included. Baseline characteristics are summarized in table 1. All procedures employed electrocautery enhanced Axios lumen apposing metal stents (LAMS) (Boston, Mass), 15x10mm in 7 (53.8 %) patients and 20x10mm in the remaining cases. Median procedure time was 49 minutes (IQR: 34-70), achieving technical success in 12 (92.3 %) and clinical success in 9 (69.2 %). Three of the four clinical failures died during admission, 2 due to aspiration pneumonia and a third due to a GI bleeding from a drained walled-off necrosis. The fourth clinical failure was a superior mesenteric artery syndrome who presented severe pain after oral intake and presented no improvement after receiving the EUS-GE. Among those reaching clinical success, 4 maintained the stent in situ after a median follow-up of 306 days (range 190-645), 3 (33 %) underwent an uneventful scheduled stent removal after a median of 79 days (range 76-110) and 2 (22.2 %) presented a clinical relapse after 64 and 195 days, respectively. One patient underwent surgery while the other received a second EUS-GE with a 20x10 mm LAMS.

Tab. 1

Stricture location, n (%)	Duodenum 9 (69.2 %) Pilorus 4 (30.8 %)
Etiology, n (%)	Peptic 4 (30.8 %) Acute pancreatitis 2 (15.4 %) Diabetic gastroparesis 2 (15.4 %) Idiopathic 2 (15.4 %) Other 3 (23.1 %)
Previous endoscopic treatment	None 9 (69.2 %) SEMS 3 (23.1 %) Balloon dilation 1 (7.7 %)
Baseline oral tolerance, n (%)	Nil per os 6 (46.2 %) Liquid diet 5 (38.5 %) Soft diet 2 (15.4 %)

Conclusions EUS-GE reached clinical success in 9 (69.2 %) patients. Although clinical relapse was observed in 2 (22.2 %) patients, only one required surgery during follow-up.

Citation Sánchez-Delgado L, García-Alonso FJ, Chavarría C et al. eP436 EUS-GUIDED GASTROENTEROSTOMY AS TREATMENT OF BENIGN GASTRIC OUTLET OBSTRUCTION. Endoscopy 2021; 53: S240.

Publication History

Article published online:
19 March 2021