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

D Luna-Rodriguez; C Loras; S Bazaga; J Colan-Hernandez; H Carlos; C Guarner-Argente; L Barranco Priego; C Claudia; M González-Haba Ruiz; M Rodriguez-Tellez; P Ruiz-Ramirez; F Bas-Cutrina; E Nuñez; S Maisterra; M Hombrados; M Murzi Pulgar; B Agudo; S G Albert; I Salvador; B Laquente; M Calvo; A Lagarda; J B Gornals

doi:10.1055/s-0045-1805197

Endoscopy, Inhaltsverzeichnis

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

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

²Hospital Universitari Mútua Terrassa, Terrassa, Spain

³Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
S Bazaga

⁴Hospital General de Granollers, Granollers, Spain
J Colan-Hernandez

⁵Hospital Germans Trias i Pujol, Badalona, Spain
H Carlos

⁶Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
C Guarner-Argente

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

⁸Hospital del Mar, Barcelona, Spain
C Claudia

¹Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
M González-Haba Ruiz

⁹Department of Gastroenterology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
M Rodriguez-Tellez

¹⁰hospital universitario virgen macarena, Sevilla, Spain
P Ruiz-Ramirez

¹¹Hospital Universitari MútuaTerrassa, Terrassa, Spain
F Bas-Cutrina

⁴Hospital General de Granollers, Granollers, Spain
E Nuñez

¹²Germans Trias i Pujol Hospital, Badalona, Spain
S Maisterra

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

⁶Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
M Murzi Pulgar

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

¹⁴Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
S G Albert

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

¹¹Hospital Universitari MútuaTerrassa, Terrassa, Spain

³Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
B Laquente

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

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

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

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

¹⁸Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain

Abstract

Volltext

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.

Referenzen

References
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2 Jovani M, Ichkhanian Y, Parsa N. et al. Assessment of the learning curve for EUS-guided gastroenterostomy for a single operator. Gastrointest Endosc 2021; 93 (05): 1088-1093
3 Teoh AYB, Lakhtakia S, Tarantino I. et al. Endoscopic ultrasonography-guided gastroenterostomy versus uncovered duodenal metal stenting for unresectable malignant gastric outlet obstruction (DRA-GOO): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9 (02): 124-132