CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(02): E144-E150
DOI: 10.1055/a-0799-9939
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction

Tossapol Kerdsirichairat*
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Shayan Irani*
2  Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
,
Juliana Yang
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Olaya I. Brewer Gutierrez
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Robert Moran
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Omid Sanaei
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Mohamad Dbouk
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vivek Kumbhari
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vikesh K. Singh
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Anthony N. Kalloo
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Mouen A. Khashab
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

submitted 12 September 2018

accepted after revision 09 November 2018

Publication Date:
30 January 2019 (online)

  

Abstract

Background and study aims EUS-guided gastroenterostomy (GE) is a novel, minimally invasive endoscopic procedure for the treatment of gastric outlet obstruction (GOO). The direct-EUS-GE (D-GE) approach has recently gained traction. We aimed to report on a large cohort of patients who underwent DGE with focus on long-term outcomes.

Patients and methods This two-center, retrospective study involved consecutive patients who underwent D-GE between October 2014 and May 2018. The primary outcomes were technical and clinical success. Secondary outcomes were adverse events (AEs), rate of reintervention, procedure time, time to resume oral diet, and post-procedure length of stay (LOS).

Results A total of 57 patients (50.9 % female; median age 65 years) underwent D-GE for GOO. The etiology was malignant in 84.2 % and benign in 15.8 %. Technical success and clinical success were achieved in 93 % and 89.5 % of patients, respectively, with a median follow-up of 196 days in malignant GOO and 319.5 days in benign GOO. There were 2 (3.5 %) AEs, one severe and one moderate. Median procedure time was 39 minutes (IQR, 26 – 51.5 minutes). Median time to resume oral diet after D-GE was 1 day (IQR 1 – 2 days). Median post D-GE LOS was 3 days (IQR 2 – 7 days). Rate of reintervention was 15.1 %.

Conclusions D-GE is safe and effective in management of both malignant and benign causes of GOO. Clinical success with D-GE is durable with a low rate of reintervention based on a long-term cohort.

* These authors contributed equally.