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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(09): E1194-E1201
DOI: 10.1055/a-1214-5659
Original article

Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

Janine B. Kastelijn
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Leon M.G. Moons
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Francisco J. Garcia-Alonso
2   Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
,
Manuel Pérez-Miranda
2   Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
,
Viliam Masaryk
3   Department of Gastroenterology and General Internal Medicine, SRH Wald-Klinikum, Gera, Germany
,
Uwe Will
3   Department of Gastroenterology and General Internal Medicine, SRH Wald-Klinikum, Gera, Germany
,
Ilaria Tarantino
4   Gastroenterology and Endoscopy Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Palermo, Italy
,
Hendrik M. van Dullemen
5   Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
,
Rina Bijlsma
6   Department of Gastroenterology and Hepatology, Martini Hospital Groningen, Groningen, The Netherlands
,
Jan-Werner Poley
7   Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Matthijs P. Schwartz
8   Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
,
Frank P. Vleggaar
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Letter to:

Can endoscopic ultrasound-guided gastroenterostomy be used as a first-line modality for endoscopic management of malignant gastric outlet obstruction?Endosc Int Open 2021; 09(03): E421-E422
DOI: 10.1055/a-1339-1230

Abstract

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) is a novel, minimally invasive technique in the palliative treatment of malignant gastric outlet obstruction (GOO). Several studies have demonstrated feasibility and safety of EUS-GE, but evidence on long-term durability is limited. The aim of this study was to evaluate patency of EUS-GE in treatment of malignant GOO.

Patients and Methods An international multicenter study was performed in seven centers in four European countries. Patients who underwent EUS-GE with a LAMS between March 2015 and March 2019 for palliative treatment of symptomatic malignant GOO were included retrospectively. Our main outcome was recurrent obstruction due to LAMS dysfunction; other outcomes of interest were technical success, clinical success, adverse events (AEs), and survival.

Results A total of 45 patients (mean age 69.9 ± 12.3 years and 48.9 % male) were included. Median duration of follow-up was 59 days (interquartile range [IQR] 41–128). Recurrent obstruction occurred in two patients (6.1 %), after 33 and 283 days of follow-up. Technical success was achieved in 39 patients (86.7 %). Clinical success was achieved in 33 patients (73.3 %). AEs occurred in 12 patients (26.7 %), of which five were fatal. Median overall survival was 57 days (IQR 32–114).

Conclusions EUS-GE showed a low rate of recurrent obstruction. The relatively high number of fatal AEs underscores the importance of careful implementation of EUS-GE in clinical practice.



Publication History

Received: 25 February 2020

Accepted: 28 May 2020

Article published online:
31 August 2020

© 2020. Owner and Copyright ©

© Georg Thieme Verlag KG
Stuttgart · New York

Refers to:

Malignant GOO: Are duodenal stenting and surgical gastrojejunostomy obsolete?Endosc Int Open 2020; 08(10): E1455-E1457
DOI: 10.1055/a-1231-5011

 

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