Direct EUS-guided gastrojejunostomy (EUS-GJ) for the management of gastric outlet obstruction (GOO). Case series from a tertiary hospital

Aims To perform a descriptive analysis of all the EUS- GJ performed in our center from 2016-2023 and to compare the cases performed by direct puncture of the loop to the ones assisted by nasobiliary catheter to establish possible predictor factors of using the direct technique over the assisted one.

Methods We performed a descriptive analysis of all the EUS-GJ performed in the study period. Then we performed a descriptive analysis of assisted and direct EUS-GJ. A univariate analysis comparing the two techniques and a multivariate analysis taking into account the variables with p<0.05 in the univariate analysis was performed.

Results Out of 87 EUS-GJ, technical success was achieved in 89.7%, with 73 (83.9%) being malignant stenosis. We had complications in 7 procedures (8%). Of all these, 7 (8%) were performed by direct loop puncture. The technical and clinical success rate of direct EUS-GJ was 85.7% with no complications.

100% of the strictures were malignant in these cases. In 4 cases (57,1%) the neoplasm was pancreatic, in 2 (28,6%) duodenal and in 1 (14,3%) gastric. The site of the stenosis was distal (beyond the second duodenal portion) in 6 cases (57,1%) and 42,9% of the cases had tumor necrosis. In the univariate analysis, it was observed that there were satistically significant differences (p<0,05) in the distal location of the stenosis, tumor necrosis and duodenal tumor in direct EUS-GJ compared to the assisted cases. There was also a tendency to a higher use of 15 x 10 mm luminal apposing metal stents compared to the assisted technique (p=0,08).

In the multivariate analysis, necrosis, distal location and duodenal tumor maintained statistical significance (p<0,05).

Conclusions Direct EUS-GJ is a safe technique, with high technical and clinical success rates, most frequently used when there is a distal stenosis, tumor necrosis and the tumor is duodenal. However, this is a single-center study with a small series of cases, so we need more studies to validate these results.

Publication History

Article published online:
15 April 2024