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Endoscopy 2023; 55(11): 991-999
DOI: 10.1055/a-2119-7529
Original article

Endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stents: a retrospective multicentric comparison of wireless and over-the-wire techniques

Laurent Monino  ‡   ‡
1   Department of Gastroenterology and Hepatology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
2   Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
,
Enrique Perez-Cuadrado-Robles  ‡   ‡
3   Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
4   University of Paris-Cité, Paris, France
,
Jean-Michel Gonzalez
2   Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
,
Christophe Snauwaert
5   Department of Gastroenterology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
,
Hadrien Alric
3   Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
4   University of Paris-Cité, Paris, France
,
Mohamed Gasmi
2   Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
,
Sohaib Ouazzani
2   Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
,
Hedi Benosman
3   Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
,
Pierre H. Deprez 
1   Department of Gastroenterology and Hepatology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
,
Gabriel Rahmi
3   Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
4   University of Paris-Cité, Paris, France
,
Christophe Cellier
3   Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
4   University of Paris-Cité, Paris, France
,
Tom G. Moreels 
1   Department of Gastroenterology and Hepatology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
,
Marc Barthet 
2   Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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Referred to by:

Author commentary on Laurent Monino et al.Endoscopy 2023; 55(11): v36-v36
DOI: 10.1055/a-2140-9235

Referred to by:

Endoscopic ultrasound-guided gastroenterostomy: another knock-out for simplificationEndoscopy 2023; 55(11): 1000-1001
DOI: 10.1055/a-2164-9630

Abstract

Background Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMSs) appears to be effective and safe in gastric outlet obstruction (GOO); however, the EUS-GE procedure is not standardized, with the use of assisted or direct methods still debated. The aim of this study was to compare the outcomes of EUS-GE techniques focusing on an assisted with orointestinal drain wireless endoscopic simplified technique (WEST) and the nonassisted direct technique over a guidewire (DTOG).

Method This was a multicenter European retrospective study involving four tertiary centers. Consecutive patients who underwent EUS-GE for GOO between August 2017 and May 2022 were included. The primary aim was to compare the technical success and adverse event (AE) rates of the different EUS-GE techniques. Clinical success was also analyzed.

Results 71 patients (mean [SD] age 66.2 [10] years; 42.3 % men; 80.3 % malignant etiology) were included. Technical success was higher in the WEST group (95.1 % vs. 73.3 %; estimate of relative risk from odds ratio (eRR) 3.2, 95 %CI 0.94–10.9; P = 0.01). The rate of AEs was lower in the WEST group (14.6 % vs. 46.7 %; eRR 2.3, 95 %CI 1.2–4.5; P = 0.007). Clinical success was comparable between the two groups at 1 month (97.5 % vs. 89.3 %). The median follow-up was 5 months (range 1–57).

Conclusion The WEST resulted in a higher technical success rate with fewer AEs, with clinical success comparable with the DTOG. Therefore, the WEST (with an orointestinal drain) should be preferred when performing EUS-GE.

‡ Co-first authors


Figs. 1 s-3 s



Publication History

Received: 21 December 2022

Accepted: 28 June 2023

Accepted Manuscript online:
28 June 2023

Article published online:
01 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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