Surgical Endoscopy

, Volume 31, Issue 7, pp 2946–2952 | Cite as

EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction

  • Yen-I Chen
  • Takao ItoiEmail author
  • Todd H. Baron
  • Jose Nieto
  • Yamile Haito-Chavez
  • Ian S. Grimm
  • Amr Ismail
  • Saowanee Ngamruenphong
  • Majidah Bukhari
  • Gulara Hajiyeva
  • Ahmad S. Alawad
  • Vivek Kumbhari
  • Mouen A. Khashab


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).


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.


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).


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.


Gastric outlet obstruction Endoscopic ultrasound Stents Endoscopy 


Compliance with ethical standards


Dr. Mouen A. Khashab is a consultant for Boston Scientific. Drs. Yen-I Chen, Takao Itoi, Todd H. Baron, Jose Nieto, Yamile Haito-Chavez, Ian S. Grimm, Amr Ismail, Saowanee Ngamruenphong, Majidah Bukhari, Gulara Hajiyeva Ahmad S. Alawad, and Vivek Kumbhari have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Yen-I Chen
    • 1
  • Takao Itoi
    • 2
    Email author
  • Todd H. Baron
    • 3
  • Jose Nieto
    • 4
  • Yamile Haito-Chavez
    • 1
  • Ian S. Grimm
    • 3
  • Amr Ismail
    • 1
  • Saowanee Ngamruenphong
    • 1
  • Majidah Bukhari
    • 1
  • Gulara Hajiyeva
    • 1
  • Ahmad S. Alawad
    • 1
  • Vivek Kumbhari
    • 1
  • Mouen A. Khashab
    • 1
  1. 1.Division of Gastroenterology and HepatologyJohns Hopkins Medical InstitutionsBaltimoreUSA
  2. 2.Division of Gastroenterology and HepatologyTokyo Medical UniversityShinjuku-kuJapan
  3. 3.Division of Gastroenterology and HepatologyUniversity of North CarolinaChapel HillUSA
  4. 4.Borland-Groover ClinicJacksonvilleUSA

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