SAFETY AND EFFICACY OF DOUBLE EUS-BYPASS VERSUS SURGICAL HEPATICOJEJUNOSTOMY AND GASTROJEJUNOSTOMY

Aims Both gastric outlet obstruction (GOO) and biliary obstruction may occur simultaneously in individual patients. Small series have suggested that double EUS-bypass is feasible. Our aim was to compare same-session double EUS-bypass to open surgical hepaticojejunostomy and gastrojejunostomy.

Methods A tertiary single-center retrospective analysis was performed of all consecutive double EUS-procedures performed from 2018 to March 2021. Consecutive historical surgical controls were extracted from the institutional database. For EUS-guided gastroenterostomy the WEST-technique was used, whereas for biliary obstruction, EUS-guided hepaticogastrostomy, rendez-vous, choledocho-bulbostomy or antegrade stenting were allowed.

Results In total (n=42), 12 patients (28.6%) were treated with EUS and 30 patients with surgery (71.4%). At baseline, EUS-treated patients showed a higher Charlson Comorbidity Index (9.0 vs. 6.5, p=0.011). Technical success was achieved in 91.7% of EUS-treated patients vs. 100% in the surgical group (p=1.000). Clinical success, defined as a GOOS score>2 and serum bilirubin decrease>50%, was achieved in 66.7% and 70.0% respectively (p=0.833). In the EUS group, median time to oral intake (1.0 vs. 6.0 day(s), p<0.001) and median hospital stay were significantly shorter (11.0 vs 23.0 days, p=0.001). Using the ASGE lexicon, the total number of adverse events (AE) was similar in both groups (5 [41.7%] vs. 15 [46.7%] events, p=1.000), with an even distribution in severe, moderate and mild AE.

Conclusions Despite being used in a patient population with more comorbid conditions and more advanced disease stage, double EUS-bypass achieved similar efficacy and safety, as well as shorter hospital stay and time to oral intake, when compared to surgery.

Publication History

Article published online:
14 April 2022