EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques.

Abstract

BACKGROUND:

EUS-guided gastroenterostomy (EUS-GE) is a developing modality in the management of gastric outlet obstruction (GOO) with several technical approaches, including the direct and balloon-assisted techniques. The aim of this study was to compare the direct with the balloon-assisted modality while further defining the role of EUS-GE in GOO.

METHODS:

This multicenter, retrospective study involved consecutive patients who underwent EUS-GE with the direct or balloon-assisted technique for GOO (January 2014 to October 2016). The primary outcome was technical success. Secondary outcomes were success (ability to tolerate at least a full fluid diet), procedure time, and rate/severity of adverse events (AEs).

RESULTS:

A total of 74 patients (44.6% women; mean age 63.0 ± 11.7 years) underwent EUS-GE for GOO (direct gastroenterostomy, n = 52; balloon-assisted gastroenterostomy, n = 22). GOO was of malignant and benign etiology in 66.2% and 33.8% of patients, respectively. Technical success was achieved in 94.2% of the direct and 90.9% of the balloon-assisted approach (P = .63). Mean procedure time was shorter with the direct technique (35.7 ± 32.1 minutes vs 89.9 ± 33.3 minutes, P < .001). The clinical success rate was 92.3% for the direct technique and 90.9% for the balloon-assisted modality (P = 1.00), with a mean time to oral intake of 1.32 ± 2.76 days. The AE rate was 6.8% with only 1 severe AE noted. Rate of AEs, postprocedure length of stay, need for reintervention, and survival were similar between the 2 groups.

CONCLUSIONS:

EUS-GE is effective and safe in the management of GOO. The direct technique may be the preferred method given its shorter procedure time when compared with the balloon-assisted approach. Prospective trials are needed to confirm these findings.

• Authors: Yen-I Chen, Rastislav Kunda, Andrew C Storm, Hanaa Dakour Aridi, Christopher C Thompson, Jose Nieto, Theodore James, Shayan Irani, Majidah Bukhari, Olaya Brewer Gutierrez, Amol Agarwal, Lea Fayad, Robert Moran, Nuha Alammar, Omid Sanaei, Marcia I Canto, Vikesh K Singh, Todd H Baron, Mouen A Khashab
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 87 Issue 5 Pg. 1215-1221 (May 2018) ISSN: 1097-6779 [Electronic] United States
• PMID: 28750837 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Endosonography (methods)
• Female
• Gastric Outlet Obstruction (surgery)
• Gastroenterostomy (methods)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Surgery, Computer-Assisted (methods)
• Treatment Outcome