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Endoscopy 2022; 54(02): 170-172
DOI: 10.1055/a-1392-4546
Innovations and brief communications

Modified endoscopic ultrasound-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS): a pilot study

Amanda Marino
1   Division of Gastroenterology and Hepatology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
,
Ali Bessissow
2   Division of Interventional Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
,
Corey Miller
3   Division of Gastroenterology and Hepatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
,
David Valenti
2   Division of Interventional Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
,
Louis Boucher
2   Division of Interventional Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
,
Prosanto Chaudhury
4   Department of Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
,
Jeffrey Barkun
4   Department of Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
,
Nauzer Forbes 
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Mouen A. Khashab
6   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland, USA
,
Myriam Martel
1   Division of Gastroenterology and Hepatology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
,
Yen-I Chen 
1   Division of Gastroenterology and Hepatology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Abstract

Introduction We recently developed a double-balloon device, using widely available existing technology, to facilitate endoscopic ultrasound-guided gastroenterostomy (EUS-GE). Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS).

Methods This was a single-center retrospective study of consecutive patients undergoing M-EPASS from January 2019 to August 2020. The double-balloon device consists of two vascular balloons that optimize the distension of a targeted small-bowel segment for EUS-guided stent insertion. The primary end point was the rate of technical success.

Results 11 patients (45 % women; mean [standard deviation (SD)] age 64.9 [8.6]) with malignant gastric outlet obstruction were included. Technical and clinical success (ability to tolerate an oral diet) were achieved in 91 % (10/11) and 80 % (8/10) of patients, respectively. There was one adverse event (9 %) due to stent migration. Two patients (18 %) required re-intervention for stent obstruction secondary to food impaction. The mean (SD) time to a low residue diet was 3.5 (2.4) days.

Conclusion M-EPASS appears to facilitate the technique of EUS-GE, potentially enhancing its safety and clinical adoption. Larger studies are needed to validate this innovative approach to gastric outlet obstruction.

Figs. 1s–3s, Tables 1s, 2s



Publication History

Received: 26 November 2020

Accepted: 16 February 2021

Accepted Manuscript online:
16 February 2021

Article published online:
20 April 2021

© 2021. Thieme. All rights reserved.

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