DIRECT ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY WITH LUMEN-APPOSING METAL STENTS: A RETROSPECTIVE BICENTER STUDY ON TECHNICAL FEASIBILITY AND CLINICAL OUTCOME

Aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with lumen apposing metal stents (LAMS) appears to be a promising intervention in the management of gastroduodenal obstruction as a less invasive alternative to surgery. The aim of this study was to evaluate the feasibility, safety and clinical outcome of direct EUS-GE in patients of surgical high-risk or in a palliative setting.

Methods This retrospective bicenter study included patients who underwent direct EUS-GE with LAMS (April 2017 to November 2019) investigating feasibility, technical success (correctly placed LAMS), clinical outcome (successful oral nutrition) and procedure-associated complications. Direct EUS-GE was performed using the Hot-Axios-Stent (Boston Scientific; n = 1: 10 × 10 mm, n = 5: 15 × 10 mm, n = 5: 20 × 10 mm). For this, the intestinal target loop was filled with fluids and subsequently directly punctured with the stent delivery system followed by stent release under endosonographic control.

Results A total of 24 patients (50% men/50% women; mean age 67.2 years) underwent direct EUS-GE for gastroduodenal obstruction of malignant (n = 21), benign (n = 2) or unknown (n = 1) etiology.

The technical success rate of correctly placed LAMS was 100% (24/24). However, in 17 % of patients (4/24) the distal flange of the stent was unintendedly released in the peritoneal cavity due to loss of contact to the target loop while performing the first puncture but correct stent placement succeeded in a second attempt. 92% of the patients (22/24) benefited from the intervention by showing reduced nausea and vomiting and the ability of oral food intake.

Conclusions Direct EUS-GE with LAMS has a favorable risk-benefit-profile for patients with gastroduodenal obstruction showing high technical success rates, manageable complications and rapid symptom relief.