Details

Autor(en) / Beteiligte

• Chen, Yen-I
• Itoi, Takao
• Baron, Todd H.
• Nieto, Jose
• Haito-Chavez, Yamile
• Grimm, Ian S.
• Ismail, Amr
• Ngamruenphong, Saowanee
• Bukhari, Majidah
• Hajiyeva, Gulara
• Alawad, Ahmad S.
• Kumbhari, Vivek
• Khashab, Mouen A.

Titel

EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction

Ist Teil von

• Surgical endoscopy, 2017-07, Vol.31 (7), p.2946-2952

Ort / Verlag

New York: Springer US

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• Background and aims Endoscopic enteral stenting (ES) in malignant gastric outlet obstruction (GOO) is limited by high rates of stent obstruction. EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers sustained patency without tumor ingrowth/overgrowth. The aim of this study is to compare EUS-GE with ES in terms of (1) symptom recurrence and need for re-intervention, (2) technical success (proper stent positioning as determined via endoscopy and fluoroscopy), (3) clinical success (ability to tolerate oral intake without vomiting), and (4) procedure-related adverse events (AEs). Methods Multicenter retrospective study of all consecutive patients who underwent either EUS-GE at four centers between 2013 and 2015 or ES at one center between 2008 and 2010. Results A total of 82 patients (mean age 66-years ± 13.5 and 40.2% female) were identified: 30 in EUS-GE and 52 in ES. Technical and clinical success was not significantly different: 86.7% EUS-GE versus 94.2% ES ( p  = 0.2) and 83.3% EUS-GE versus 67.3% ES ( p  = 0.12), respectively. Symptom recurrence and need for re-intervention, however, was significantly lower in the EUS-GE group (4.0 vs. 28.6%, ( p  = 0.015). Post-procedure mean length of hospitalization was comparable at 11.3 days ± 6.6 for EUS-GE versus 9.5 days ± 8.3 for ES ( p  = 0.3). Rates and severity of AEs (as per the ASGE lexicon) were also similar (16.7 vs. 11.5%, p  = 0.5). On multivariable analysis, ES was independently associated with need for re-intervention (OR 12.8, p  = 0.027). Conclusion EUS-GE may be ideal for malignant GOO with comparable effectiveness and safety to ES while being associated with fewer symptom recurrence and requirements for re-intervention.