Impact On Nutritional Status Of Eus-Guided Gastroenterostomy In Patients With A Malignant Duodenal Stenosis

Aims The endoscopic ultrasound guided gastroenterostomy (EUS-GE) is an alternative to the duodenal stent in patients with a malignant stenosis. This challenging technique may have larger patency times with a lower reintervention rate compared to duodenal stents at expenses of a higher intraoperative complication rate. However, the impact on nutritional status in these patients is unknown.

Methods Observational single-center study. All consecutive patients who underwent a EUS-GE in 2020 because of a malignant gastric outlet syndrome were included. A lumen apposing metal stent of 20mm was used. Clinical and biological variables and nutritional status were measured 48h before the procedure and for 3 months follow-up.

Results Seventeen patients underwent a EUS-GE. Seven were excluded because the purpose of the technique was not for alimentation but drainage of malignant afferent limb syndrome or access to excluded jejunal limb in post-surgical anatomy. Dix patients (mean age: 64±13,73yr, 50 % male) with a pancreatic cancer (n = 7, 70 %), cholangiocarcinoma (n = 1, 10 %), gastric cancer (n = 1, 10 %) or neuroendocrine tumor (n = 1, 10 %) were finally included.

Before the procedure, the median OMS index was 1 (range:0-2) and a metastatic disease or carcinosis were confirmed in 3 (30 %) and 2 (20 %) cases. A previous duodenal stent was present in 60 % of cases.

The technical success was 80 % with a direct access (n = 7) or guidewire assisted (n = 3) techniques. Clinical success was 100 % with a normal oral diet (n = 7, 87.5 %) or mixed oral diet (n = 1, 12.5 %) 48h after the procedure. Enteral nutrition was left in place in only two cases (20 %). No complications, reintervention rate or mortality. An improvement of the weight (55kg vs. 53kg,p = 0.043) and BMI (20.8 kg/m² vs. 19.98 kg/m²,p = 0.043) were confirmed (Table 1).

Tab. 1

Variable	Before EUS-GE (48h)	Follow-up	P-value
Leucocytes (g/L)	6.95 (4.1-19.4)	9,6 (4,7-12,4)	0.686
Albumin (d/L)	30,5 (22-39)	34,5 (22-37)	0.336
Weight (kg)	53 (48-65)	55 (49,5-69)	0.043*
BMI (kg/m2)	19,98 (17,6-22,7)	20,8 (18,2-24,4)	0.043*

Conclusions EUS-GE is a safe technique with high technical and clinical success improving the nutritional status and allowing to withdraw complementary enteral nutrition.

Citation Perez-Cuadrado Robles E, Perrod G, Benosman H et al. eP439 IMPACT ON NUTRITIONAL STATUS OF EUS-GUIDED GASTROENTEROSTOMY IN PATIENTS WITH A MALIGNANT DUODENAL STENOSIS. Endoscopy 2021; 53: S241.

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Artikel online veröffentlicht:
19. März 2021