Aims Gastric outlet obstruction (GOO) is a clinical syndrome caused by benign and malignant
mechanical obstruction. Balloon dilation, self-expandable metal stents (SEMS) and
surgical gastroenterostomy are classical therapeutic options. The authors aim to assess
the effectiveness and safety of EUS-guided gastroenterostomy (EUS-GE) for GOO.
Methods Case-series of EUS-GE performed by a single operator in a EUS high-volume/reference
center. In all cases direct EUS-GE technique was applied: after 0.035´´guidewire placement
through the proximal jejunum, a 7-french nasobiliary drain is inserted, allowing jejunal
distension through saline/iodate contrast/methylene blue infusion. Using a linear
echoendoscope through the gastric wall, a distended loop is identified and EUS-guided
puncture with a 19G needle is performed, after which a lumen-apposing metal stent
(20x10mm LAMS; Hot AXIOS) is deployed. Flow of blue mixture to the lumen confirms
successful gastroenterostomy creation [1]
[2]
[3].
Results 11 patients (9 male/2 female; mean age 74 years) underwent EUS-GE due to GOO caused
by pancreatic adenocarcinoma (n=5), gastric adenocarcinoma (n=3), ampulloma (n=1),
urothelial cancer (n=1) and after surgery of a perforated ulcer (n=1) causing duodenal
stenosis. Weight loss/food intolerance/postprandial vomiting were the main symptoms
and upper endoscopy confirmed GOO diagnosis. In the benign GOO patient, two sessions
of balloon dilation until 20mm were attempted with poor clinical/endoscopic improvement.
Antibiotic prophylaxis was always performed. Technical success rate was 82% (9/11).
In two patients, recurrent colon interposition and stent misdeployment in the duodenal
bulb precluded the procedure. No other adverse events were observed. All patients
were hospitalized overnight and resumed oral feeding the day after the procedure.
No symptom recurrence was observed after 3-6 months follow-up.
Conclusions EUS-GE is a safe and effective minimally invasive technique for patients with benign
or malignant GOO, without the surgical risks and the limited long-term efficacy of
SEMS. High technical success, fewer adverse events and patient clinical improvement
are expected in EUS reference centers.
