Endoscopy 2020; 52(S 01): S230-S231
DOI: 10.1055/s-0040-1704720
ESGE Days 2020 ePoster Podium presentations
Saturday, April 25, 2020 14:30 – 15:00 EUS-guided anastomoses ePoster Podium 7
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC ULTRASOUND-GUIDED GASTRO-ENTERIC ANASTOMOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

G Antonelli
1   Sapienza University of Rome, Endoscopy Unit, Rome, Italy
,
B Kovacevic
2   Herlev Hospital, Copenhagen University, Gastro Unit, Division of Endoscopy, Copenhagen, Denmark
,
JG Karsensten
3   Hvidovre Hospital, Copenhagen University, Gastro Unit, Copenhagen, Denmark
,
E Kalaitzakis
2   Herlev Hospital, Copenhagen University, Gastro Unit, Division of Endoscopy, Copenhagen, Denmark
4   University of Heraklion, Department of Gastroenterology, Heraklion, Greece
,
G Vanella
1   Sapienza University of Rome, Endoscopy Unit, Rome, Italy
,
C Hassan
5   Nuovo Regina Margherita Hospital, Endoscopy Unit, Rome, Italy
,
P Vilmann
2   Herlev Hospital, Copenhagen University, Gastro Unit, Division of Endoscopy, Copenhagen, Denmark
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Endoscopic-ultrasound (EUS)-guided gastro-enteric anastomosis using lumen-apposing metal stents (LAMS) is emerging as an alternative, minimally-invasive therapy for treating gastric outlet obstruction (GOO), as well as restoring bowel continuity in patients with surgically altered anatomy. Literature on this subject is heterogeneous, with variable reporting of techniques and outcomes.

Our aim was to perform a meta-analysis of published data on EUS-guided enteric anastomosis, providing a pooled estimate of technical and clinical outcomes.

Methods The protocol was registered in PROSPERO (Reg. no. CRD42018111110). PubMed, Embase, Scopus, and Web of Science databases were searched until February 2019 for studies describing > 5 patients undergoing EUS-guided enteric anastomosis. Screening of titles/abstracts, full-text review, and data extraction was performed by two authors. Data regarding indication, technique, technical and clinical success, adverse events, follow-up were collected. PRISMA methodology was used. Pooled technical and clinical success and adverse events rates were calculated. Quality, publication bias, and heterogeneity were explored.

Results Twelve studies (290 patients) were included. Main procedure indication was GOO(62.4%). Direct puncture technique was the most frequent(68.2%). Pooled technical success rate was 93.5%[95% confidence interval (CI) 89.7–6.0%;I2:0%], while clinical success rate was 90.1%[95% CI 85.5–93.4%;I2:0%]. Pooled total adverse events rate was 11.7% [95% CI 8.2–16.6;I2:0%]. When stratified for adverse event severity, mild/moderate pooled adverse event rate was 10.6% [95% CI 7–15.6;I2:3.4%], while severe/fatal adverse event rate was 2.9% [95% CI 1.4–6;I2:0%]. Mean procedure time was 63.5 ± 35.7 minutes, and mean length of hospital stay 4.9 ± 2.7 days. No publication bias or heterogeneity was found, although some included studies were graded low quality.

Conclusions EUS-guided enteric anastomosis, performed by expert endoscopists in referral centres, has a high rate of technical and clinical success. The procedure appears to be relatively safe, and a minimally invasive alternative to surgery in expert hands. Further prospective studies and technique standardisation are warranted to generalise these results.