Safety and efficacy of endoscopic ultrasound-guided gastroenterostomy using double balloon occlusion methods: a clinical retrospective study in 36 patients with malignant gastric outlet obstruction

Guifang Xu; Yonghua Shen; Ying Lv; Xiaoliang Zhou; Wen Li; Yi Wang; Shahzeb Hassan; Lei Wang; Xiaoping Zou

doi:10.1055/a-1221-9656

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1690-E1697
DOI: 10.1055/a-1221-9656

Original article

Safety and efficacy of endoscopic ultrasound-guided gastroenterostomy using double balloon occlusion methods: a clinical retrospective study in 36 patients with malignant gastric outlet obstruction

Authors

Guifang Xu‡

¹Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
Yonghua Shen‡

¹Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
Ying Lv

¹Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
Xiaoliang Zhou

¹Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
Wen Li

¹Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
Yi Wang

¹Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
Shahzeb Hassan

²Northwestern University Feinberg School of Medicine, Chicago 60611, IL, United States
Lei Wang

¹Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
Xiaoping Zou

¹Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School

Abstract

Background and study aims Gastric outlet obstruction (GOO) is common in the late stage of many malignant tumors of the digestive system. Endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) is commonly used for palliative treatment of malignant GOO. The objective of this study was to investigate the safety, efficacy, and prognosis of EUS-GE in treatment of malignant GOO in Chinese patients.

Patients and methods This was a retrospective, single-center study with 36 consecutive patients with malignant GOO who were treated with EUS-GE. The main outcome measures were technical success rate, clinical success rate, incidence of adverse events (AEs), and median survival time.

Results A total of 36 patients with malignant GOO underwent double-balloon-assisted EUS-GE between March 2017 and June 2019 in our hospital. GOO occurred mainly in elderly men (mean age 69.0 years, M:F 0.89). The most common etiology of GOO was pancreatic cancer (41.7 %). The most common obstruction site was the second part of the duodenum (63.9 %). The technical success rate was 100 % (36/36). The clinical success rate was 94.4 % (34/36). Median time for the total procedure was 52 minutes (range 34 – 156 min). Median time for determination of puncture site was 20 minutes (range 15 – 28 min). Median time between puncture and successful delivery of the stent was 38 minutes (range 19 – 128 min). The GOOSS score was 0.2 before EUS-GE. The GOO Scoring System (GOOSS) score was 2.2 at 15 days after the EUS-GE (P = 0.001). The GOOSS score was still higher than 2 during a median follow-up period of 89 days. AEs were observed in nine patients (25.0 %) and 13 total AEs occurred. One patient died as a result of delayed stent migration and bleeding. Mean length of hospital stay was 5.8 ± 4.7 days. The median survival period was 103 days. The rate of GOO recurrence was 2.7 % (1/36).

Conclusion EUS-GE was associated with increased safety and efficacy for treatment of malignant GOO in Chinese Mainland.

Full Text

References

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