Development of a monitoring strategy for EUS gastroenterostomy in benign indications : a survey of european french-speaking expert echoendoscopists

Aims EUS-guided gastroenterostomy (EUS-GE) is a minimally invasive procedure to treat gastric outlet obstruction. The lack of standardization in technique still limits its use to high volumes of therapeutic echoendoscopy (expert center). Additionally, the absence of knowledge on long term follow-up prevents extending the indications of EUS-GE to benign pathologies. We conducted a study practices among expert echoendoscopists to identify a dominant strategy for medium and long-term surveillance after performing EUS-GE for benign indication.

Methods An invitation to complete a questionnaire was sent by email with the helping of French society of digestive endoscopy (SFED), to 34 experts from 25 french-speaking centers (19 French centers, 4 Belgian centers and 2 swiss centers). The respondents were asked about the technical aspects of performing EUS-GE and their surveillance strategies for EUS-GE in benign indications.

Results 31 experts responded to this practice questionnaire (91.2%). 14 (45.1%) reported having performed more than 25 EUS-GE procedures regardless of the indication. Among them 6 (6/31, 19.4%) reported having performed more than 7 EUS-GE for benign indications. Since January 2024, 18 participants (58.1%) reported having perfomed between 1 and 3 EUS-GE and 4 participants (12.9%) reported having performed more than 4 EUS-GE for benign procedures. From a technical point, all participants reported using the HotAxios system (Boston Scientific) (31/31, 100%), preferably of 20 mm size (26/31, 83.9%). The method providing the best visibility of the target loop was the oro-intestinal drain for 29 experts (93.5%), associated with the “free hand” method (30/31, 96.8%). 23 (74.2%) experts reported regular follow-up after EUS-GE for benign indications. Among them, 5 proposed follow-up every 3 months (21.7%) and 10 proposed endoscopic follow-up every 6 months (43.5%). A removal strategy was adopted by 13 (41.9%) experts (including 9 at least one year). A replacement strategy was proposed by 13 (41.9%) experts (including 8 at least one year). An adaptable strategy depending on the indication was proposed by the other experts (5, 16.1%). The main criteria precipitating the removal of the LAMS were the regression of the initial pathology (67.9%) or the presence of ulcers (35.7%) or jejunal perforation (42.9%). The main criteria in favour of replacement were LAMS age of more than 6 months (46.5%) or the presence of tissue overgrowth or ingrowth in the LAMS (42.9%).

Conclusions All experts agree on a technique for performing EUS-GE that combines the oro-intestinal drain and “free hand” puncture of the target limb regardless of the indication. A large majority of experts also agree on the need for endoscopic follow-up in patients with EUS-GE for benign pathologies. The results of this survey help identify the follow-up elements and removal/replacement strategies used by all experts. These data help refine the protocols for future studies on EUS-GE for benign indications.

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Artikel online veröffentlicht:
27. März 2025