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Endoscopic Ultrasound-Guided Gastroenterostomy (EUS-GE)

  • Steven P. Shamah
  • Uzma D. SiddiquiEmail author
Chapter
  • 341 Downloads

Abstract

Gastric outlet obstruction is a mechanical obstruction that typically involves the distal stomach or proximal duodenum. Presenting signs and symptoms include nausea, vomiting, early satiety, and abdominal distention. Common etiologies range from malignant (pancreatic cancer) to benign causes (peptic ulcer disease). Historic management options consist of surgical gastrojejunostomy formation that is durable but carries significant morbidity and mortality compared to enteral stenting that while safer is far less durable. Endoscopic ultrasound (EUS)-guided creation of a gastroenterostomy has been facilitated by the off-label use of the lumen apposing metal stent and various techniques consisting of water immersion method, balloon assisted method, double balloon gastroenterostomy bypass (EPASS), and Direct method. The technical success rate of EUS-GE ranges from 90% to 92% in the reported literature with a clinical success rate (defined as able to tolerate PO diet) of 85%. Several case series and comparative studies have confirmed that EUS-GE can be performed with high technical and clinical success rates. Recent data has suggested that this approach for the treatment of GOO may also be a more cost-effective option compared to surgical gastrojejunostomy and more durable than enteral stenting.

Keywords

Gastroenterostomy Gastric outlet obstruction GOO EUS-guided Enteral stenting Surgical gastrojejunostomy 

Supplementary material

Video 15.1

Video depicting EUS-guided gastroenterostomy creation using the balloon assisted technique. (MP4 139505 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Center for Endoscopic Research and Therapeutics (CERT)University of ChicagoChicagoUSA

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