Endoscopy 2020; 52(S 01): S80-S81
DOI: 10.1055/s-0040-1704243
ESGE Days 2020 oral presentations
Friday, April 24, 2020 08:30 – 10:30 EUS-guided interventions Liffey Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC ULTRASONOGRAPHY-GUIDED GASTROENTEROSTOMY IS A PROMISING ENDOSCOPIC TECHNIQUE FOR PALLIATIVE TREATMENT OF GASTRIC OUTLET OBSTRUCTION. A MULTICENTER NATIONAL EXPERIENCE

R Sanchez-Aldehuelo
1   Hospital Universitario Ramón y Cajal, Madrid, Spain
,
ER de Santiago
1   Hospital Universitario Ramón y Cajal, Madrid, Spain
,
SP Herce
2   Clinica Universidad de Navarra, Pamplona, Spain
,
JC Súbtil Íñigo
2   Clinica Universidad de Navarra, Pamplona, Spain
,
JRA Tormo
3   Hospital General Universitario de Alicante, Alicante, Spain
,
FGH Lladó
4   Hospital Arnau de Vilanova, Lleida, Spain
,
AS Yagüe
5   Hospital Costa del Sol, Marbella, Spain
,
JG Soler
6   Hospital Universitario de Bellvitge, Barcelona, Spain
,
AR Ortega
7   Complejo Hospitalario de Toledo, Spain, Spain
,
CG Argente
8   Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
,
JRF Olcina
1   Hospital Universitario Ramón y Cajal, Madrid, Spain
,
A Albillos
1   Hospital Universitario Ramón y Cajal, Madrid, Spain
,
E Vázquez-Sequeiros
1   Hospital Universitario Ramón y Cajal, Madrid, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 

Aims Background Endoscopic ultrasound (EUS)-guided gastrojejunostomy (EUS-GJ) is an alternative for treating gastric outlet obstruction (GOO) in expert centers. It remains unknown if these results may be reproducible in less experienced institutions.

Aims To conduct a nationwide study to evaluate the outcomes of EUS-GJ at institutions with no experience on EUS-GJ.

Methods

Study period: 07/2017-11/2019.

Inclusion criteria: Patients undergoing EUS-GJ for palliative therapy of malignant GOO.

Exclusion criteria:

  1. EUS-GJ performed by a non-malignant condition;

  2. Patients from institutions with experience in EUS-GJ. Technique: Nasobiliary tube for irrigation of jejunum+EUS-guided hot-axios.

Outcomes:

  1. Technical-success: successful hot-axios placement for EUS-GJ;

  2. Clinical-success: ability to resume oral intake after EUS-GJ; and

  3. Adverse events(AEs).

All institutions performing EUS-GJ in our country participated in the study and all attempts of EUS-GJ performed were recorded (intention to treat analysis).

Results 64 patients (age 72±11years; male:61%) from 8 institutions, meeting study criteria, were included. Aetiology for GOO: pancreatic/gastric cancer (42 patients:66%)/(22 patients:34%). The most common location of obstruction was second/third portion of duodenum (30/64=47%). A 10x20 mm LAMS was inserted in 42/64 patients (66%) and a 10x15 mm LAMS was placed in 22/64 (36%). Technical success: 62/64(97%;IQR: 89-99%) patients; clinical success: 61/64(95%;IQR:87-98%); adverse events: 5/64(8%;IQR:3-16%), the majority during the procedure (Median time to AE: 0 days;IQR:0-17;range:0-154):

  • Early-AEs: Perforation in 1/64(1.6%), requiring endoscopic treatment; bleeding: 1/64(1.6%), requiring surgery; death in 1/64(1.6%) due to gastric aspiration;

  • Delayed-AEs: stent migration in 2/64(3.2%), occurring at 17 and 154 days, respectively and being solved endoscopically. No stent obstruction was found during follow-up (0%). Median follow-up time of the overall cohort was 56 days(IQR:0.5-141.5;range:0.5-514).

Conclusions EUS-GJ appears to be technically feasible, clinically effective and safe for treating malignant GOO in institutions with no prior experience. AEs are infrequent, mostly amenable for endoscopic repair, and tend to occur within the procedure.