Preferred techniques for endoscopic ultrasound-guided gastroenterostomy: a survey of expert endosonographers

 

 Buy Article Permissions and Reprints

Abstract

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an emerging procedure that lacks technical standardization with limited adoption beyond expert centers. We surveyed high-volume endosonographers about the technical aspects of EUS-GE to describe how the procedure is currently performed at expert centers and identify targets for standardization.

Methods Invitations to complete an electronic survey were distributed to 21 expert EUS practitioners at 19 U.S. centers. Respondents were surveyed about technical aspects of EUS-GE, indications, efficacy, safety, and attitudes toward the procedure.

Results All 21 (100%) invited expert endoscopists completed the survey. Nine (42.9%) reported performing >10 EUS-GEs in the last 12 months. About half (47.6%, 10/21) puncture the target loop prior to lumen-apposing metal stent (LAMS) introduction, most often to confirm the loop is jejunum. No respondents reported guidewire placement prior to LAMS introduction. Most (71.4%, 15/21) do not use a guidewire at any time, while 28.6% (6/21) reported wire placement after distal flange deployment to secure the tract during apposition. Eight (38.1%, 8/21) reported at least one major adverse event, most commonly intraperitoneal LAMS deployment (87.5%, 7/8). Factors most often reported as advantageous for EUS-GE over enteral stenting included lack of papilla interference (33.3%, 7/21) and decreased occlusion risk (23.8%, 5/21).

Conclusions Significant variation in performance technique for EUS-GE exists among expert US endoscopists, which may hinder widespread adoption and contribute to inconsistencies in reported patient outcomes. The granularity provided by these survey results may identify areas to focus standardization efforts and guide future studies on developing an ideal EUS-GE protocol.

Publication History

Received: 02 August 2023

Accepted after revision: 15 September 2023

Accepted Manuscript online:
04 October 2023

Article published online:
09 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Carbajo AY, Kahaleh M, Tyberg A. Clinical review of EUS-guided gastroenterostomy (EUS-GE). J Clin Gastroenterol 2020; 54: 1-7 DOI: 10.1097/MCG.0000000000001262. (PMID: 31567785)
  CrossrefPubMedGoogle Scholar
• 2 Iqbal U, Khara HS, Hu Y. et al. EUS-guided gastroenterostomy for the management of gastric outlet obstruction: A systematic review and meta-analysis. Endosc Ultrasound 2020; 9: 16-23 DOI: 10.4103/eus.eus_70_19. (PMID: 31898587)
  CrossrefPubMedGoogle Scholar
• 3 Chen YI, Itoi T, Baron TH. et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 2017; 31: 2946-2952
  CrossrefPubMedGoogle Scholar
• 4 Ge PS, Young JY, Dong W. et al. EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction. Surg Endosc 2019; 33: 3404-3411 DOI: 10.1007/s00464-018-06636-3. (PMID: 30725254)
  CrossrefPubMedGoogle Scholar
• 5 Khashab MA, Kumbhari V, Grimm IS. et al. EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc 2015; 82: 932-938
  CrossrefPubMedGoogle Scholar
• 6 Khashab MA, Baron TH, Binmoeller KF. et al. EUS-guided gastroenterostomy: a new promising technique in evolution. Gastrointest Endosc 2015; 81: 1234-1236 DOI: 10.1016/j.gie.2014.12.053. (PMID: 25864896)
  CrossrefPubMedGoogle Scholar
• 7 Irani S, Itoi T, Baron TH. et al. EUS-guided gastroenterostomy: techniques from East to West. VideoGIE 2020; 5: 48-50
  CrossrefPubMedGoogle Scholar
• 8 Irani S, Baron TH, Itoi T. et al. Endoscopic gastroenterostomy: techniques and review. Curr Opin Gastroenterol 2017; 33: 320-329 DOI: 10.1097/MOG.0000000000000389. (PMID: 28767501)
  CrossrefPubMedGoogle Scholar
• 9 On W, Huggett MT, Young A. et al. Endoscopic ultrasound guided gastrojejunostomy in the treatment of gastric outlet obstruction: multi-centre experience from the United Kingdom. Surg Endosc 2023; 37: 1749-1755
  CrossrefPubMedGoogle Scholar
• 10 Tyberg A, Perez-Miranda M, Sanchez-Ocaña R. et al. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 2016; 4: E276-E281
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Itoi T, Baron TH, Khashab MA. et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc 2017; 29: 495-502 DOI: 10.1111/den.12794. (PMID: 28032663)
  CrossrefPubMedGoogle Scholar
• 12 Tonozuka R, Tsuchiya T, Mukai S. et al. Endoscopic ultrasonography-guided gastroenterostomy techniques for treatment of malignant gastric outlet obstruction. Clin Endosc 2020; 53: 510-518 DOI: 10.5946/ce.2020.151. (PMID: 32962331)
  CrossrefPubMedGoogle Scholar
• 13 Stefanovic S, Draganov PV, Yang D. Endoscopic ultrasound guided gastrojejunostomy for gastric outlet obstruction. World J Gastrointest Surg 2021; 13: 620-632 DOI: 10.4240/wjgs.v13.i7.620. (PMID: 34354796)
  CrossrefPubMedGoogle Scholar
• 14 Hashimoto T, Adachi K, Ishimura N. et al. Safety and efficacy of glucagon as a premedication for upper gastrointestinal endoscopy--a comparative study with butyl scopolamine bromide. Aliment Pharmacol Ther 2002; 16: 111-118
  CrossrefPubMedGoogle Scholar
• 15 Park KH, Rosas US, Liu QY. et al. Safety of teaching endoscopic ultrasound-guided gastroenterostomy (EUS-GE) can be improved with standardization of the technique. Endosc Int Open 2022; 10: E1088-E1094
  Article in Thieme ConnectPubMedGoogle Scholar
• 16 Chen YI, Kunda R, Storm AC. et al. EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques. Gastrointest Endosc 2018; 87: 1215-1221 DOI: 10.1016/j.gie.2017.07.030. (PMID: 28750837)
  CrossrefPubMedGoogle Scholar
• 17 McCarty TR, Garg R, Thompson CC. et al. Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E1474-E1482 DOI: 10.1055/a-0996-8178. (PMID: 31673620)
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Kumar A, Chandan S, Mohan BP. et al. EUS-guided gastroenterostomy versus surgical gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2022; 10: E448-E458 DOI: 10.1055/a-1765-4035. (PMID: 35433208)
  Article in Thieme ConnectPubMedGoogle Scholar
• 19 Jovani M, Ichkhanian Y, Parsa N. et al. Assessment of the learning curve for EUS-guided gastroenterostomy for a single operator. Gastrointest Endosc 2021; 93: 1088-1093 DOI: 10.1016/j.gie.2020.09.041. (PMID: 32991868)
  CrossrefPubMedGoogle Scholar
• 20 Wani S, Han S, Simon V. et al. Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. Gastrointest Endosc 2019; 89: 1160-1168
  CrossrefPubMedGoogle Scholar
• 21 No JH, Kim SW, Lim CH. et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc 2013; 78: 55-62
  CrossrefPubMedGoogle Scholar
• 22 Sánchez-Aldehuelo R, Subtil Iñigo JC, Martínez Moreno B. et al. EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: results from a nationwide multicenter retrospective study (with video). Gastrointest Endosc 2022; 96: 1012-1020
  CrossrefPubMedGoogle Scholar
• 23 Wannhoff A, Ruh N, Meier B. et al. Endoscopic gastrointestinal anastomoses with lumen-apposing metal stents: predictors of technical success. Surg Endosc 2021; 35: 1997-2004
  CrossrefPubMedGoogle Scholar

• Supplementary Material