Long-term Outcome for In Situ LAMS in Entero-enteric and Gastro-enteric Anastomosis for Benign Diseases

Aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMS) is an effective treatment of gastric outlet obstruction (GOO) in malignant setting. Due his minimally invasive approach it has shown potential as an alternative to surgery for benign conditions such as GOO and afferent loop syndrome. Long-term outcome data are lacking, and optimal duration stent placement remains unclear. This study aimed to evaluate the safety and efficacy of EUS-guided gastroenteroanastomosis (GEA) and enteroenteroanastomosis (EEA) as treatments for benign gastrointestinal pathologies.

Methods We conducted a retrospective study including consecutive patients who underwent EUS-guided GEA or EEA at Niguarda Hospital, Milan (January 2020-October 2024) minimun follow-up 6 months. Primary endpoints were technical success, adverse events (AEs), long-term clinical success. Clinical outcomes for GEA patients were assessed by improvement in body mass index (BMI) and Gastric Outlet Obstruction Scoring System (GOOSS). EEA outcomes were evaluated based on symptom relief.

Results Thirteen patients were included (GEA=10, EEA=3), mean age 52.3 years (± 20.7). Technical success was 100%. GEA indications: gastroparesis (n=2), peptic disease (n=2), post-pancreatitis stenosis (n=2), eosinophilic duodenitis (n=1), duodenal anastomosis stenosis (n=1), tuberculosis (n=1), and groove pancreatitis (n=1). EEA indications: afferent loop syndrome (n=2), severe biliary reflux (n=1). Median stent indwelling time was 683 days (IQR: 302-827 days). GEA patients had a significant BMI increase (mean+3.42 kg/m², p<0.005) and GOOSS improvement (mean 1.2 pre-GEA; 3.0 post-GEA, p<0.05) All patients were able to tolerate a full diet post-GEA. All patients were able to tolerate a full diet post GEA. All EEA patients reported symptom relief. We recorded 3 AEs: 1 dumping syndrome, 1 bleeding with periprosthetic ulcer, 1 obstruction for food debris. 3 patients died during FU for reasons unrelated to the procedure [1] [2] [3] [4] [5].

Conclusions EUS-guided GEA and EEA are technically effective and safe options for patients with GOO and may represent a new therapeutic perspective for long-term complications of post-surgical gastrointestinal reconstructions. This technique allows for improvement in nutritional status and quality of life, avoiding major surgery. This study presents data with the longest follow-up reported so far. The median stent indwelling time suggests good durability with a low rate of adverse events. Main limitations are retrospective design and small sample size.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Michiel Bronswijk, MD et al. Laparoscopic versus EUS-guided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score-matched comparison
• 2 Jia-Su Li et al. 2023 EUS-guided gastroenterostomy for gastric outlet obstruction: a comprehensive meta-analysis
• 3 Schalk W. van der Merwe et al 2022 Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
• 4 Theodore W. James, MD et al. 2020 EUS-Guided Gastroenteric Anastomosis as A Bridge to Definitive Treatment In Benign Gastric Outlet Obstruction
• 5 Yen-I Chen et al. 2017 EUS-guided gastroenterostomy in management of benign gastric outlet obstruction