Aims Gastric outlet obstruction (GOO) caused by malignancy lays a high burden of suffering on affected patients. Symptom relief and restoring the capability of ingesting food orally is a major contribution to improve quality of life. Several treatment options for this clinical problem are available, e.g. balloon dilation of the stenosis, stenting or surgical gastrojejunostomy (GJ) can be performed.
An evolving technique to overcome the clinical problem of malignant GOO is EUS-guided gastrojejunostomy (EUS-GJ) with placement of a self-expanding metal stent creating a bypass of the stenosis.
The question of effectiveness and safety of this approach was addressed in 13 consecutive patients treated with EUS-GJ by creating the bypass with a Hot Axios SEMS in a German tertiary care university hospital.
Methods 13 consecutive patients with malignant GOO were treated with EUS-GJ from 05/2019 until 09/2020 (Hot Axios SEMS 10/20, Boston Scientific). Technical (correct positioning of the stent) and clinical (improvement of GOO symptoms) success as well as complications were recorded.
Results 13 patients (46 % female; mean age 75 years) underwent EUS-GJ for malignant GOO (pancreatic cancer 8/13, duodenal cancer 2/13, HCC, CCA, gastric cancer each one). Technical success and clinical success were achieved in 11/13 patients (84,6 %) with a mean follow-up of 89 days. There were 2 (15,3 %) severe AEs (misdeployment of the stents) with emergency surgical GJ performed. Both patients recovered soon. All other patients were able to restart diet the day after the intervention. Mean procedure time was 95 minutes (30 – 170). Mean length of stay in hospital post EUS-GJ was 6,2 days (3-19). No endoscopic re-intervention was necessary.
Conclusions EUS-GJ with SEMS (Hot Axios 10/20mm) appears to be a safe and effective therapeutic option for malignant GOO. Randomized controlled trials to evaluate its value compared to surgical GJ are required.
Citation
Weber T, Gölder SK, Braun G et al. eP443 EUS-GUIDED GASTROJEJUNOSTOMY IN MALIGNANT GASTRIC OUTLET OBSTRUCTION – SAFETY, TECHNICAL AND CLINICAL SUCCESS. Endoscopy 2021; 53: S243.
