EUS-guided gastroenterostomy outcomes in a peripheral single-center series: a retrospective analysis of the first 3 years’ experience

Aims Endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) is an advanced, minimally invasive procedure primarily indicated in patients with malignant gastric outlet obstruction (GOO) as an alternative to traditional enteral stenting or surgery. EUS-GE are generally performed in expert centers with a technical success rate ranging from 92% to 100%, a clinical success rate of around 90%, and 11%–12% of adverse events (AEs). However, this study aims to describe our experience in a single peripherical center.

Methods Retrospective evaluation of the results of EUS-GE performed in a single peripherical center from November 2021 to November 2024, including EUS-direct trans-enteric endoscopic retrograde cholangiopancreatography (EDEE). Wireless endoscopic simplified technique (WEST) and direct technique over a guidewire (DTOG) for EUS-GE are applied [1] [2] [3].

Results A total of 20 patients (15:5,M:F), median age of 76 years old (36-90) were included. All patients were symptomatic with nausea, vomiting, and inappetence with evidence of GOO. In 15 cases (75%), EUS-GE was performed in an advanced oncological setting: 6 patients presenting with pancreatic cancer, 4 with gastric cancer (including 1 EDEE in a recurrence case after Roux-en-Y gastrectomy), 3 with ampullary/duodenal cancer, 2 with carcinosis due to colon cancer. The remaining 5 patients underwent EUS-GE for EDEE (1 case) or refractory benign GOO: 2 due to stenosing peptic ulcer not responding to other treatments; 2 due to pancreatitis-related duodenal strictures. WEST was used in 18 cases and DTOG in 2. A 20x10 mm lumen apposing metal stent (LAMS) was used in all cases. Technical success was reached without AEs in 90% of cases (18). In 2 cases (10%) a distal flange maldeployment (both DTOG) was recognized and solved in the same session: prolonging the LAMS with an esophageal fully covered metal stent in one case and bridging with another LAMS performing natural orifice transluminal endoscopic surgery in the other one. Median EUS-GE procedural time was 55 minutes (40-200). Clinical success was 100%. Six patients (30%) died for oncological progression after a median of 135 days (30-510).

Conclusions EUS-GE is a challenging endoscopic procedure with high technical and clinical success, as described in tertiary care centers. Our results showed reasonable technical and clinical success even in peripheral centers if capable of recognizing and managing intra-procedural complications.

Publication History

Article published online:
27 March 2025

• References

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