Clinical and technical outcomes of patients undergoing endoscopic ultrasound-guided gastroenterostomy using 20-mm vs. 15-mm lumen-apposing metal stents

Abstract

Background Most studies on endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) for palliation of malignant gastric outlet obstruction (GOO) utilized a 15-mm lumen-apposing metal stent (LAMS). More recently, a 20-mm LAMS has become available. This study aimed to compare rates of technical and clinical success and adverse events (AEs) in patients undergoing EUS-GE using a 20-mm vs. 15-mm LAMS.

Methods Patients who underwent EUS-GE with 15-mm or 20-mm LAMS for malignant GOO during the period from January 2018 to October 2020 were included. The primary outcome was clinical success, defined as an increase in the gastric outlet obstruction score (GOOS) by at least 1 point during follow-up. Secondary outcomes were technical success, maximum tolerated diet, re-intervention rate, and rate/severity of AEs.

Results 267 patients (mean age 67 years, 43 % women) with malignant GOO from 19 centers underwent EUS-GE. Clinical success rates were similar for the 15-mm and 20-mm stents (89.2 % [95 %CI 84.2 %–94.2 %] vs. 84.1 % [77.4%–90.6 %], respectively). However, a significantly higher proportion of patients in the 20-mm group tolerated a soft solid/complete diet at the end of follow-up (91.2 % [84.4 %–95.7 %] vs. 81.2 % [73.9 %–87.2 %], P = 0.04). Overall, AEs occurred in 33 patients (12.4 % [8.4 %–16.3 %]), with similar rates for 15-mm and 20-mm stents (12.8 % [7.5 %–18.2 %] vs. 11.8 % [6 %–17.6 %]), including incidence of severe/fatal AEs (2 % [0.4 %–5.8 %] vs. 3.4 % [0.9 %–8.4 %]).

Conclusions The 20-mm and 15-mm LAMS show similar safety and efficacy for patients undergoing EUS-GE for malignant GOO. The 20-mm LAMS allows a more advanced diet and is, thus preferred for EUS-GE.

Publication History

Received: 18 May 2021

Accepted: 27 September 2021

Accepted Manuscript online:
27 September 2021

Article published online:
14 January 2022

• References

• 1 Chen YI, James TW, Agarwal A. et al. EUS-guided gastroenterostomy in management of benign gastric outlet obstruction. Endosc Int Open 2018; 6: E363-E368
• 2 James TW, Greenberg S, Grimm IS. et al. EUS-guided gastroenteric anastomosis as a bridge to definitive treatment in benign gastric outlet obstruction. Gastrointest Endosc 2020; 91: 537-542
• 3 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
• 4 Carbajo AY, Kahaleh M, Tyberg A. Clinical review of EUS-guided gastroenterostomy (EUS-GE). J Clin Gastroenterol 2020; 54: 1-7
• 5 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
• 6 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
• 7 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
• 8 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
• 9 Betés M, Pérez-Longo P, Peralta S. et al. Feasibility and patency of echoendoscopic anastomoses with lumen apposing metal stents depending on the gastrointestinal segment involved. Sci Rep 2021; 11: 3992
• 10 Kerdsirichairat T, Irani S, Yang J. et al. Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction. Endosc Int Open 2019; 7: E144-E150
• 11 Kouanda A, Binmoeller K, Hamerski C. et al. Endoscopic ultrasound-guided gastroenterostomy versus open surgical gastrojejunostomy: clinical outcomes and cost effectiveness analysis. Surg Endosc 2021; DOI: 10.1007/s00464-020-08221-z.
• 12 Lajin M. EUS-guided choledocoduodenostomy and gastroenterostomy to palliate simultaneous biliary and duodenal obstruction due to pancreatic cancer. Endosc Int Open 2020; 8: E1681-E1682
• 13 Lajin M. EUS-guided gastroenterostomy assisted by extrinsic abdominal compression to treat gastric obstruction after surgical resection of a GI stromal tumor. VideoGIE 2021; 6: 77-79
• 14 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
• 15 Irani S, Itoi T, Baron TH. et al. EUS-guided gastroenterostomy: techniques from East to West. VideoGIE 2020; 5: 48-50
• 16 Khashab MA, Baron TH, Binmoeller KF. et al. EUS-guided gastroenterostomy: a new promising technique in evolution. Gastrointest Endosc 2015; 81: 1234-1236
• 17 Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002; 97: 72-78
• 18 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 19 Madanat L, Saumoy M, Sharaiha RZ. Endoscopic gastrojejunostomy – bigger is better. Endoscopy 2018; 50: E331-E332