ENDOSCOPIC ULTRASOUND GUIDED GASTROENTERIC ANASTOMOSES IN FIVE PATIENTS WITH UPPER GASTROINTESTINAL MALIGNANCIES – A RETROSPECTIVE CASE SERIES

Aims Gastric outlet obstruction (GOO) is a common complication to advanced malignancies in the upper gastrointestinal (GI) tract. Traditionally, first line palliative treatment consists of duodenal stenting or surgical gastroenteric anastomosis (GEA). The effect of duodenal stenting may be limited by tissue ingrowth (uncovered stents) or stent migration (fully or partially covered stents) and the patient may be unfit for surgery. Endoscopic ultrasound-guided GEA (EUS-GEA) may then be an alternative.

Methods From January to November 2019, all patients that underwent EUS-GEA in our department were included in a retrospective case series. The indication was GOO in all patients. The stents were all lumen apposing metal stents (HOT AXIOS, Boston Scientific Corp) with a diameter and saddle length of 15mm and 10 mm, respectively.

Results Five patients were included with age ranging from 66 to 91 years. Three patients had pancreatic cancer, one had duodenal cancer, and one had pancreatic metastases from a colonic cancer. The intervention was technically successful in all patients (100%). However, due to aspiration caused by a second lower obstruction, one patient deceased the day after the procedure. All patients resumed full per oral nutrition and none were readmitted due to GOO. One patient resumed palliative chemotherapy and is still alive seven months after the intervention, while the remaining three patients deceased between six days and 2 months post intervention due to their malignant disease.

Conclusions GOO is a severe and possibly life-threatening complication to upper GI malignancy. EUS-GEA can provide long-term palliation in GOO patients possibly enabling reinstitution of oncological treatment, making it an important tool in palliative patient care. However, prospective, comparative trials are warranted.