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DOI: 10.1055/s-0043-115386
Double endoscopic bypass for gastric outlet obstruction and biliary obstruction
Publikationsverlauf
submitted 22. April 2017
accepted after revision 23. Juni 2017
Publikationsdatum:
13. September 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201709/lookinside/thumbnails/895_10-1055-s-0043-115386-1.jpg)
Abstract
Background and study aims Double endoscopic bypass entails EUS-guided gastroenterostomy (EUS-GE) and EUS-guided biliary drainage (EUS-BD) in patients who present with gastric outlet and biliary obstruction. We report a multicenter experience with double endoscopic bypass.
Patients and methods Retrospective, multicenter series involving 3 US centers. Patients who underwent double endoscopic bypass for malignant gastric and biliary obstruction from 1/2015 to 12/2016 were included. Primary outcome was clinical success defined as tolerance of oral intake and resolution of cholestasis. Secondary outcomes included technical success, re-interventions and adverse events (AE).
Results Seven patients with pancreatic head cancer (57.1 % females; mean age 64.6 ± 12.5 years) underwent double endoscopic bypass. Four patients had EUS-GE and EUS-BD performed during the same session with a mean procedure time of 70 ± 20.4 minutes. EUS-GE and EUS-BD were technically successful in all patients, all of whom were able to tolerate oral intake with resolution of cholestasis in 6 (87.5 %). One patient had a repeat EUS-BD with normalization of bilirubin. There were no adverse events.
Conclusions Double endoscopic bypass is feasible and effective when performed by experienced operators. Studies comparing this novel concept to existing techniques are warranted.
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References
- 1 Lillemoe KD, Cameron JL, Hardacre JM. et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 1999; 230: 322-328 ; discussion 328-330
- 2 Khashab MA, Valeshabad AK, Leung W. et al. Multicenter experience with performance of ERCP in patients with an indwelling duodenal stent. Endoscopy 2014; 46: 252-255
- 3 Khashab MA, Fujii LL, Baron TH. et al. EUS-guided biliary drainage for patients with malignant biliary obstruction with an indwelling duodenal stent (with videos). Gastrointest Endosc 2012; 76: 209-213
- 4 Itoi T, Baron TH, Khashab MA. et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc 2016; 29: 495-502
- 5 Khashab MA, Baron TH, Binmoeller KF. et al. EUS-guided gastroenterostomy: a new promising technique in evolution. Gastrointest Endosc 2015; 81: 1234-1236
- 6 Khashab MA, Kumbhari V, Grimm IS. et al. EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc 2015; 82: 932-938
- 7 Khashab MA, Levy MJ, Itoi T. et al. EUS-guided biliary drainage. Gastrointest Endosc 2015; 82: 993-1001
- 8 Khashab MA, El Zein M, Ngamruengphong S. et al. Double endoscopic bypass by using lumen-apposing stents (with videos). Gastrointest Endosc 2016; 83: 435-439
- 9 Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002; 97: 72-78
- 10 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
- 11 Chen YI, Itoi T, Baron TH. et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 2016; 1-7
- 12 Khashab MA, Valeshabad AK, Modayil R. et al. EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). Gastrointest Endosc 2013; 78: 734-741
- 13 Khashab M, Alawad AS, Shin EJ. et al. Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 2013; 27: 2068-2075
- 14 Khashab MA, Valeshabad AK, Afghani E. et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci 2015; 60: 557-565
- 15 Nakai Y, Hamada T, Isayama H. et al. Endoscopic management of combined malignant biliary and gastric outlet obstruction. Dig Endosc. 2017 Jan 29: 16-25
- 16 Imai H, Kitano M, Omoto S. et al. EUS-guided gallbladder drainage for rescue treatment of malignant distal biliary obstruction after unsuccessful ERCP. Gastrointest Endosc 2016; 84: 147-151