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

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An Erratum to this article was published on 17 July 2017

This article has been updated

Abstract

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.

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Change history

  • 17 July 2017

    An erratum to this article has been published.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Yen-I Chen, Yamile Haito-Chavez, Amr Ismail, Saowanee Ngamruenphong, Majidah Bukhari, Gulara Hajiyeva, Ahmad S. Alawad, Vivek Kumbhari & Mouen A. Khashab

  2. Division of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan

    Takao Itoi

  3. Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA

    Todd H. Baron & Ian S. Grimm

  4. Borland-Groover Clinic, Jacksonville, FL, USA

    Jose Nieto

Authors
  1. Yen-I Chen
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  2. Takao Itoi
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  3. Todd H. Baron
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  13. Mouen A. Khashab
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Corresponding author

Correspondence to Takao Itoi.

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Disclosures

Dr. Mouen A. Khashab is a consultant for Boston Scientific. Drs. Yen-I Chen, Takao Itoi, Todd H. Baron, Jose Nieto, Yamile Haito-Chavez, Ian S. Grimm, Amr Ismail, Saowanee Ngamruenphong, Majidah Bukhari, Gulara Hajiyeva Ahmad S. Alawad, and Vivek Kumbhari have no conflicts of interest or financial ties to disclose.

Additional information

An erratum to this article is available at https://doi.org/10.1007/s00464-017-5723-6.

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Chen, YI., Itoi, T., Baron, T.H. et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 31, 2946–2952 (2017). https://doi.org/10.1007/s00464-016-5311-1

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  • DOI: https://doi.org/10.1007/s00464-016-5311-1

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