EUS-guided gastroenterostomy: the first U.S. clinical experience (with video)

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• 作者：Mouen A. Khashab ; MD<sup>1sup><sup> ; sup> ; Vivek Kumbhari ; MD<sup>1sup> ; Ian S. Grimm ; MD<sup>2sup> ; Saowanee Ngamruengphong ; MD<sup>1sup> ; Gerard Aguila ; RN<sup>1sup> ; Mohamad El Zein ; MD<sup>1sup> ; Anthony N. Kalloo ; MD<sup>1sup> ; Todd H. Baron ; MD<sup>2sup>
• 关键词：EUS-GE ; EUS-guided gastroenterostomy ; GE ; gastroenterostomy ; GOO ; gastric outlet obstruction ; SEMS ; self-expandable metal stent
• 刊名：Gastrointestinal Endoscopy
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：82
• 期：5
• 页码：932-938
• 全文大小：1754 K

文摘

There are limitations to enteral self-expandable metal stents and surgical gastrojejunostomy in the treatment of patients with gastric outlet obstruction (GOO). EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers long-lasting luminal patency without the risk of tumor ingrowth and/or overgrowth, while avoiding the morbidity of a surgical procedure. The aims of this study were to report the first U.S. clinical experience with EUS-GE in terms of technical success, clinical success, and adverse events and to detail the technical aspects of performing EUS-GE.

sSec_2">Methods

spara0015">This was a retrospective study from two tertiary-care centers. EUS-GE was performed by using either the direct EUS-GE or balloon-assisted EUS-GE technique. Technical success was defined as adequate positioning and deployment of the stent as determined endoscopically and radiologically. Clinical success was defined as the patient&rsquo;s ability to tolerate oral intake without vomiting.

sSec_3">Results

spara0020">A total of 10 patients underwent attempted EUS-GE. Malignant GOO was present in 3 patients, whereas benign obstruction was found in the remaining 7. One patient had complete GOO and underwent successful direct EUS-GE. In the remaining 9 patients, balloon-assisted EUS-GE was attempted and was successful in 8. Thus, technical success occurred in 9 patients (90%). There were no procedure-related adverse events. Mean procedure time was 96 minutes (range 45-152 minutes), and mean length of hospital stay was 2.2 days. Clinical success with resumption of solid oral intake was achieved in all 9 patients (100%) who underwent successful EUS-GE. A total of 8 patients were able to tolerate almost a normal diet and/or full diet, and 1 patient tolerated a soft diet. There was no symptom recurrence during a mean follow-up period of 150 days.

sSec_4">Conclusions

spara0025">EUS-GE is a promising new technique for the treatment of symptoms of benign and malignant GOO. Prospective, multicenter trials are needed to confirm these results.