Advertisement

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
Article

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.

Keywords

Gastric outlet obstruction Endoscopic ultrasound Stents Endoscopy 

Notes

Compliance with ethical standards

Disclosures

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.

References

  1. 1.
    Lillemoe KD, Cameron JL, Hardacre JM et al (1999) Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 230:8–322 (discussion 328–30) Google Scholar
  2. 2.
    van Heek NT, van Geenen RC, Busch OR et al (2002) Palliative treatment in “peri”-pancreatic carcinoma: stenting or surgical therapy? Acta Gastroenterol Belg 65:171–175PubMedGoogle Scholar
  3. 3.
    Espinel J, Vivas S, Munoz F et al (2001) Palliative treatment of malignant obstruction of gastric outlet using an endoscopically placed enteral Wallstent. Dig Dis Sci 46:2322–2324CrossRefPubMedGoogle Scholar
  4. 4.
    Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97:72–78CrossRefPubMedGoogle Scholar
  5. 5.
    Oh SY, Edwards A, Mandelson M et al (2015) Survival and clinical outcome after endoscopic duodenal stent placement for malignant gastric outlet obstruction: comparison of pancreatic cancer and nonpancreatic cancer. Gastrointest Endosc 82(460–8):e2Google Scholar
  6. 6.
    Del Piano M, Ballare M, Montino F et al (2005) Endoscopy or surgery for malignant GI outlet obstruction? Gastrointest Endosc 61:421–426CrossRefPubMedGoogle Scholar
  7. 7.
    Johnsson E, Thune A, Liedman B (2004) Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World J Surg 28:812–817CrossRefPubMedGoogle Scholar
  8. 8.
    Maetani I, Tada T, Ukita T et al (2004) Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 36:73–78CrossRefPubMedGoogle Scholar
  9. 9.
    Mittal A, Windsor J, Woodfield J et al (2004) Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 91:205–209CrossRefPubMedGoogle Scholar
  10. 10.
    Watanapa P, Williamson RC (1992) Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg 79:8–20CrossRefPubMedGoogle Scholar
  11. 11.
    Dormann A, Meisner S, Verin N et al (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36:543–550CrossRefPubMedGoogle Scholar
  12. 12.
    Khashab M, Alawad AS, Shin EJ et al (2013) Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 27:2068–2075CrossRefPubMedGoogle Scholar
  13. 13.
    Fritscher-Ravens A, Mosse CA, Mukherjee D et al (2003) Transluminal endosurgery: single lumen access anastomotic device for flexible endoscopy. Gastrointest Endosc 58:585–591CrossRefPubMedGoogle Scholar
  14. 14.
    Binmoeller KF, Shah JN (2012) Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study. Endoscopy 44:499–503CrossRefPubMedGoogle Scholar
  15. 15.
    Khashab MA, Kumbhari V, Grimm IS et al (2015) EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc 82:932–938CrossRefPubMedGoogle Scholar
  16. 16.
    Tyberg A, Perez-Miranda M, Sanchez-Ocana R et al (2016) Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 4:E276–E281CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Cotton PB, Eisen GM, Aabakken L et al (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454CrossRefPubMedGoogle Scholar
  18. 18.
    Itoi T, Itokawa F, Uraoka T et al (2013) Novel EUS-guided gastrojejunostomy technique using a new double-balloon enteric tube and lumen-apposing metal stent (with videos). Gastrointest Endosc 78:934–939CrossRefPubMedGoogle Scholar
  19. 19.
    Khashab MA, Baron TH, Binmoeller KF et al (2015) EUS-guided gastroenterostomy: a new promising technique in evolution. Gastrointest Endosc 81:1234–1236CrossRefPubMedGoogle Scholar
  20. 20.
    Oh D, Lee SS, Song TJ et al (2015) Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction: a pilot study. Gastrointest Endosc 82(32–36):e1Google Scholar
  21. 21.
    Didden P, Spaander MC, de Ridder R et al (2013) Efficacy and safety of a partially covered stent in malignant gastric outlet obstruction: a prospective Western series. Gastrointest Endosc 77:664–668CrossRefPubMedGoogle Scholar
  22. 22.
    Kim CG, Choi IJ, Lee JY et al (2010) Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study. Gastrointest Endosc 72:25–32CrossRefPubMedGoogle Scholar
  23. 23.
    Kim ID, Kang DH, Choi CW et al (2010) Prevention of covered enteral stent migration in patients with malignant gastric outlet obstruction: a pilot study of anchoring with endoscopic clips. Scand J Gastroenterol 45:100–105CrossRefPubMedGoogle Scholar
  24. 24.
    Itoi T, Ishii K, Tanaka R et al (2015) Current status and perspective of endoscopic ultrasonography-guided gastrojejunostomy: endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy (with videos). J Hepatobiliary Pancreat Sci 22:3–11CrossRefPubMedGoogle Scholar

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

Personalised recommendations