ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTERIC ANASTOMOSIS: A SINGLE CENTER SERIES EMPHASIZING BENIGN INDICATIONS

Aims Endoscopic ultrasound-guided gastroenteric anastomosis (EUS-GEA) is a minimally invasive alternative to surgery for treating gastric outlet obstruction (GOO). This series is a single center cohort performing EUS-GE with the same manner, highlighting the rate of benign indications and management of stent dislodgement.

Methods We reviewed, from a prospective database, all consecutive EUS-GEA performed in a tertiary care French hospital, from January 2014 to March 2021. Procedures were performed with direct technique under EUS with simultaneous contrast filling of the jejunum and fluoroscopy control, for jejunal loop identification and LAMS (lumen apposition metal stent) deployment.

Results In total, 30 EUS-GEA were performed in 28 patients (64.3% men) with a median age of 67.5 years old (range: 31-86). Seventeen malignant cases were related to pancreatic adenocarcinoma (n=11) , ampullary tumors (n=4) and neuroendocrine tumor (n=2). Thirteen (43.3%) were performed for benign indications with duodenal stenosis related to chronic pancreatitis (n=8) and Crohn’s disease (n=2) or gastroparesis (n=2). Twenty cases (66.3%) were performed using 20mm Axios LAMS. The technical and clinical success rates were respectively 90% and 87.6% with no difference between benign and malignant indications. The perprocedural AEs rate was 16.6%, all due to LAMS misdeployment in the intraperitoneal cavity. 3/5 (60%) were successfully treated by salvage second Axios insertion with NOTES procedures and 2 with closure of the gastric perforation with OTSC clips.

Conclusions EUS-GJA seems to be ready for prime time since benign indications are almost half of cases and salvage therapy is efficient in case of stent dislodgement.

Publication History

Article published online:
14 April 2022