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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(08): E1088-E1094
DOI: 10.1055/a-1822-9864
Original article

Safety of teaching endoscopic ultrasound-guided gastroenterostomy (EUS-GE) can be improved with standardization of the technique[*]

Kenneth H. Park
1   Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Ulysses S. Rosas
1   Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Quin Y. Liu
1   Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Laith H. Jamil
2   Section of Gastroenterology and Hepatology, Beaumont Health, Royal Oak, Michigan United States
,
Kapil Gupta
1   Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Srinivas Gaddam
1   Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Nicholas Nissen
3   Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Christopher C. Thompson
4   Division of Gastroenterology Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
,
Simon K. Lo
1   Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, United States
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Comment on:

Endoscopy International Open – recently publishedEndoscopy 2022; 54(09): 922-922
DOI: 10.1055/a-1850-7727

Abstract

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique developed to manage gastric outlet obstruction (GOO). It involves creating a fistula between the stomach and the proximal small bowel using an electric cautery-enhanced lumen-apposing metal stent (ECE-LAMS) with EUS guidance. We aimed to publish our experience in improving teaching of this technique to practicing endoscopists with a wide range of experience by comparing the outcomes before and after standardization of procedural steps.

Methods All EUS-GEs performed for inoperable GOO at a single institution from 2014 to 2021 were retrospectively analyzed. The technique was taught by one experienced endoscopist with prior expertise. Five advanced endoscopists with prior EUS and ECE-LAMS placement experience participated. The impact of standardization on outcomes (clinical and technical success, length of stay [LOS], procedure time, and adverse events [AEs]) was compared.

Results A total 41 EUS-GEs were performed (5 before and 36 after standardization) by endoscopists with practice experience ranging from 2 to 13 years. The patient population was similar in age and sex. Standardization was associated with significantly higher rates of technical success (100 % vs 60 %, P = 0.01) and lower peri-procedural AEs (2.8 % vs 40 %, P = 0.03). Two AEs in the pre-standardized group were gastric perforation and gastrocolic fistula creation. One AE in the post-standardized group was gastric perforation. Procedure time, clinical success, and LOS showed improvement, although it was not statistically significant.

Conclusions Teaching EUS-GE after standardizing the procedure was associated with a significant increase in technical success and a decrease in AEs irrespective of prior total experiences.

* Meeting presentations: Digestive Disease Week 2021.


Supplementary material



Publication History

Received: 04 January 2022

Accepted after revision: 06 April 2022

Article published online:
15 August 2022

© 2022. 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
Stuttgart · New York

 

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