Abstract
Background and study aims Endoscopic ultrasound-guided gastro-enterostomy(EUS-GE) is a recently described novel
minimally invasive endoscopic procedure for patients having malignant gastric outlet
obstruction (GOO). The safety of EUS-GE in the presence of ascites with GOO is not
known. The objective of the study was to evaluate the feasibility and safety of EUS-GE
in patients with GOO and ascites.
Patients and methods Consecutive patients with GOO who underwent EUS-GE between January 2019 and March
2021 constituted the study population. EUS-GE was performed using either EPASS or
free-hand technique. The technical success, clinical success, adverse events, and
survival times were evaluated. The outcomes were compared between patients with and
without ascites.
Results A total of 31 patients with GOO underwent EUS-GE of whom 29 (93.5 %) had malignant
and two (6.4 %) had benign etiologies. Ascites was observed in 12 out of 31 (38.7%)
patients and all had underlying malignancy. Majority (27, 87 %) of the EUS-GE procedures
were performed using EPASS technique, and 4 (13 %) underwent free-hand technique.
Eleven of 12 patients with ascites and GOO underwent EUS GE using EPASS technique.
The technical success (91.6 % vs. 89.4 %; P = 0.841), clinical success (83.3 % vs. 89.4 %; P = 0.619), mean procedure time (32 vs. 31.6 min; P = 0.968) and adverse events (0 % vs. 10.5 %; P = 0.245) were not significantly different between patients with or without ascites.
However, the median survival time was significantly low in patients with ascites when
compared to without ascites (36 vs. 290 days; P < 001).
Conclusions Ascites is a common occurrence in patients with malignant GOO. EUS GE is feasible
in presence of ascites with EPASS technique.
