EUS-Guided Gastroenterostomy With A Lumen Apposing Self-Expandable Metal Stent Relieves Gastric Outlet Obstruction

Aims Gastric outlet obstruction (GOO) leads to dehydration, rapid malnourishment, vomiting and premature death. EUS-guided gastroenterostomy (EUS-GE) with lumen apposing metallic stents (LAMS) in patients with (GOO) has proven to be an alternative to luminal stenting in the duodenum and surgical gastroenterostomy. The method provides symptom relief by restoration of the luminal passage of fluid and nutrients to the small intestine in severely ill patients. Our aims were to assess the technical and clinical success and adverse events of EUS-GE, need for reintervention, and survival time after the procedure.

Methods Thirty-tree consecutive patients with GOO due to malignant tumors, metastases (n = 27), or benign conditions (n = 6) were included in this retrospective study of technical and clinical outcome. EUS-GE procedures were performed with cautery enhanced LAMS guided by EUS and fluoroscopy under general anesthesia or conscious sedation in two tertiary centers from 2016-2020.

Results Technical success was achieved in 33 patients (100 %). Median procedure time was 76 minutes and median hospital stay was three days (range 1-3). Thirty (91 %) patients were able to resume oral nutrition after the procedure. Ten patients (30 %) experienced adverse events (AEs) including migration of the stent, bleeding, and infection. Four patients had fatal AEs (12 %). These included two respiratory infections, one bleeding, and one case of re-feeding syndrome. All stent related AEs were handled endoscopically. Four patients (12 %) needed re-intervention. The median survival time for patients with malignant obstruction was 8.5 weeks (0.5-76), and 13 patients lived more than 12 weeks.

Conclusions EUS-GE is a minimally invasive and efficient method for restoration of the gastrointestinal passage and may improve palliative care for patients with GOO. The procedure carries a risk for severe AEs and should be performed in expert centers

Citation Havre RF, Dai C, Roug S et al. eP437 EUS-GUIDED GASTROENTEROSTOMY WITH A LUMEN APPOSING SELF-EXPANDABLE METAL STENT RELIEVES GASTRIC OUTLET OBSTRUCTION. Endoscopy 2021; 53: S241.

Publication History

Article published online:
19 March 2021