Endoscopy 2025; 57(S 02): S54-S55
DOI: 10.1055/s-0045-1805197
Abstracts | ESGE Days 2025
Oral presentation
EUS-guided anastomosis: let's get connected 03/04/2025, 14:30 – 15:30 Room 120+121

Learning curve assessment of EUS-guided gastroenterostomy for inexperienced centers by supervised-training: A Multicenter prospective study (GESICA project)

Authors

  • D Luna-Rodriguez

    1   Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain

  • C Loras

    2   Hospital Universitari Mútua Terrassa, Terrassa, Spain
    3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

  • S Bazaga

    4   Hospital General de Granollers, Granollers, Spain

  • J Colan-Hernandez

    5   Hospital Germans Trias i Pujol, Badalona, Spain

  • H Carlos

    6   Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain

  • C Guarner-Argente

    7   Hospital de la Santa Creu i Sant Pau, Nou Hospital, Barcelona, Spain

  • L Barranco Priego

    8   Hospital del Mar, Barcelona, Spain

  • C Claudia

    1   Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain

  • M González-Haba Ruiz

    9   Department of Gastroenterology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain

  • M Rodriguez-Tellez

    10   hospital universitario virgen macarena, Sevilla, Spain

  • P Ruiz-Ramirez

    11   Hospital Universitari MútuaTerrassa, Terrassa, Spain

  • F Bas-Cutrina

    4   Hospital General de Granollers, Granollers, Spain

  • E Nuñez

    12   Germans Trias i Pujol Hospital, Badalona, Spain

  • S Maisterra

    1   Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain

  • M Hombrados

    6   Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain

  • M Murzi Pulgar

    13   Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

  • B Agudo

    14   Puerta de Hierro Majadahonda University Hospital, Madrid, Spain

  • S G Albert

    15   Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain

  • I Salvador

    11   Hospital Universitari MútuaTerrassa, Terrassa, Spain
    3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

  • B Laquente

    16   Institut Català d'Oncologia – Hospital Duran i Reynals, L'Hospitalet de Llobregat, Spain

  • M Calvo

    16   Institut Català d'Oncologia – Hospital Duran i Reynals, L'Hospitalet de Llobregat, Spain

  • A Lagarda

    17   IDIBELL Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Spain

  • J B Gornals

    15   Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
    18   Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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Aims The standardized introduction of EUS-guided gastroenterostomy (EUS-GE) with supervised mentoring during initial cases could improve the learning curve while minimizing technical and safety-related issues.

Aims: To evaluate the impact of a training model on the learning curve for EUS-GE in inexperienced centers in terms of procedure time, technical incidents and safety [1] [2] [3].

Methods Prospective, multicenter clinical study with two parallel, non-randomized groups to analyse a teaching model (online session; teaching material; direct online tutoring) in the first EUS-GE cases. Inclusion criteria: antrum-duodenal stenoses with preserved lumen patency or complete lumen obstruction but tutorable with guidewire (allowing oroenteral catheter placement and enterography). Exclusion criteria: absolute stenosis (not tutorable with guidewire), massive ascites, gastric linitis. Intervention group: procedures performed by endoscopists with no experience in EUS-GE. Control group: Autonomous procedures by the principal investigator. Learning curve assessed by CUSUM analysis. NCT-05128604.

Results From May 2021 to October 2024, 191 patients were screened, and 152 were included (Intervention: 122, Control: 30). Pancreatic adenocarcinoma was the most common cause of obstruction (54% of cases). Obstruction localization: antrum-duodenal bulb (55%). Baseline GOOS:≤1 (97%). Overall results: technical and clinical success 96% and 93% respectively; adverse events (AE) 8%; total procedure time 53 min (SD 24). Comparative results (Intervention vs. Control group): technical / clinical success: 97% vs 100% / 94% vs 100% (n.s) respectively; AE 3% vs 9% (n.s); procedure time 56 min vs 43 min (p<0.01). Only three patients in the intervention group (3%) experienced LAMS malposition (distal flange) requiring endoscopic closure or a second EUS-GE attempt. No technical incidents associated any adverse events or needing for interventional rescue as NOTEs. CUSUM curve analysis: stable procedure time reduction achieved after 11-13 procedures.

Conclusions Preliminary results suggest this training model facilitates the successful introduction of EUS-GE, achieving high technical and clinical success while minimizing technical failures and avoiding major adverse events. Procedure time stabilizes after 11-13 cases.



Publication History

Article published online:
27 March 2025

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