Endoscopy 2023; 55(S 02): S29
DOI: 10.1055/s-0043-1765061
Abstracts | ESGE Days 2023
Oral presentation
Therapeutic EUS for upper GI diseases 20/04/2023, 11:30 – 12:30 Liffey Meeting Room 3

Endoscopic ultrasound-directed gastrojejunostomy to treat gastric outlet obstruction: which technique is the best ?

L. Monino
1   Cliniques universitaires Saint-Luc (UCLouvain), Bruxelles, Belgium
,
E. Cuadrado-Perez
2   European Hospital Georges Pompidou, Paris, France
,
J. M. Gonzalez
3   Hospital Nord, Marseille, France
,
C. Snauwaert
4   AZ Sint-Jan, Brugge, Belgium
,
M. Gasmi
3   Hospital Nord, Marseille, France
,
H. Alric
2   European Hospital Georges Pompidou, Paris, France
,
S. Ouazzani
3   Hospital Nord, Marseille, France
,
P. H. Deprez
1   Cliniques universitaires Saint-Luc (UCLouvain), Bruxelles, Belgium
,
G. Rahmi
2   European Hospital Georges Pompidou, Paris, France
,
C. Cellier
2   European Hospital Georges Pompidou, Paris, France
,
T. Moreels
1   Cliniques universitaires Saint-Luc (UCLouvain), Bruxelles, Belgium
,
M. Barthet
3   Hospital Nord, Marseille, France
› Author Affiliations
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    Aims 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. The use of assisted or direct methods is still debated. The aim of this study was to compare the outcomes of EUS-GE techniques with focus on freehand WEST and wire-guided direct approaches.

    Methods This is a multicenter European retrospective study including four tertiary centers. Consecutive patients who underwent EUS-GE between 2017 and 2022 for GOO were included. Technical success was defined as the creation of an EUS-GJ without rescue or redo technique. The primary endpoint was to compare the technical success and adverse event (AE) rates of the different EUS-GE techniques. The secondary endpoint was clinical success.

    Results A total of 85 patients were included (39% male; mean age 65.6±10 years; 69% malignant etiology). The two main methods were freehand WEST (48.2%) and wire-guided direct technique (35.8%). Technical success was higher in the first group (95.1% vs. 73.3%, OR:6.9; 95%CI [1.23; 72.12], p=0.014). The rate of AEs was lower with the WEST technique (14.6% vs. 46.7%, OR 4.98; 95%CI [1.47;18.93], p=0.007). Procedure-related mortality was 3.5% (3 patients). The clinical success was comparable in the two groups (97.5% vs. 89.3%) during a median follow-up of 7.2 months.

    Conclusions The freehand WEST technique has a higher technical success and less AEs, with a clinical success comparable to the wire-guided direct modality. Therefore, the WEST technique should be preferred ([Table 1]).

    Zoom Image
    Table 1  Outcomes of the 71 patients who underwent EUS-GE because of GOO by freehand WEST or direct wire-guided techniques.

    Outcomes of the 71 patients who underwnet EUS-GE because of GOO by freehand WEST or Direct wire-guided techniques.


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    Conflicts of interest

    Boston ScientificOlympus EuropeBraun MedicalPrion Medical

    Publication History

    Article published online:
    14 April 2023

    © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved.

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    Zoom Image
    Table 1  Outcomes of the 71 patients who underwent EUS-GE because of GOO by freehand WEST or direct wire-guided techniques.