1. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction.
- Author
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Chen, Yen-I, Itoi, Takao, Baron, Todd, Nieto, Jose, Haito-Chavez, Yamile, Grimm, Ian, Ismail, Amr, Ngamruenphong, Saowanee, Bukhari, Majidah, Hajiyeva, Gulara, Alawad, Ahmad, Kumbhari, Vivek, Khashab, Mouen, Baron, Todd H, Grimm, Ian S, Alawad, Ahmad S, Khashab, Mouen A, and Ngamruengphong, Saowanee
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GASTRIC outlet obstruction , *ENDOSCOPIC ultrasonography , *GASTROENTEROSTOMY , *SURGICAL stents , *FLUOROSCOPY , *PREVENTION , *SAFETY , *COMPARATIVE studies , *GASTROSCOPY , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *PALLIATIVE treatment , *REOPERATION , *RESEARCH , *ULTRASONIC imaging , *EVALUATION research , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DIGESTIVE organs , *DISEASE complications , *TUMORS - Abstract
Background and Aims: Endoscopic enteral stenting (ES) in malignant gastric outlet obstruction (GOO) is limited by high rates of stent obstruction. EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers sustained patency without tumor ingrowth/overgrowth. The aim of this study is to compare EUS-GE with ES in terms of (1) symptom recurrence and need for re-intervention, (2) technical success (proper stent positioning as determined via endoscopy and fluoroscopy), (3) clinical success (ability to tolerate oral intake without vomiting), and (4) procedure-related adverse events (AEs).Methods: Multicenter retrospective study of all consecutive patients who underwent either EUS-GE at four centers between 2013 and 2015 or ES at one center between 2008 and 2010.Results: A total of 82 patients (mean age 66-years ± 13.5 and 40.2% female) were identified: 30 in EUS-GE and 52 in ES. Technical and clinical success was not significantly different: 86.7% EUS-GE versus 94.2% ES (p = 0.2) and 83.3% EUS-GE versus 67.3% ES (p = 0.12), respectively. Symptom recurrence and need for re-intervention, however, was significantly lower in the EUS-GE group (4.0 vs. 28.6%, (p = 0.015). Post-procedure mean length of hospitalization was comparable at 11.3 days ± 6.6 for EUS-GE versus 9.5 days ± 8.3 for ES (p = 0.3). Rates and severity of AEs (as per the ASGE lexicon) were also similar (16.7 vs. 11.5%, p = 0.5). On multivariable analysis, ES was independently associated with need for re-intervention (OR 12.8, p = 0.027).Conclusion: EUS-GE may be ideal for malignant GOO with comparable effectiveness and safety to ES while being associated with fewer symptom recurrence and requirements for re-intervention. [ABSTRACT FROM AUTHOR]- Published
- 2017
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