Technical feasibility and clinical success of direct "free hand" EUS-guided gastroenterostomy in patients with gastric outlet obstruction

Hanna Fischer; Katharina Rüther; Mohamed Abdelhafez; Manuela Götzberger; Markus Dollhopf; Christoph Schlag

doi:10.1055/a-1907-5393

Technical feasibility and clinical success of direct "free hand" EUS-guided gastroenterostomy in patients with gastric outlet obstruction

Endosc Int Open. 2022 Oct 17;10(10):E1358-E1363. doi: 10.1055/a-1907-5393. eCollection 2022 Oct.

Authors

Hanna Fischer¹, Katharina Rüther², Mohamed Abdelhafez², Manuela Götzberger¹, Markus Dollhopf¹, Christoph Schlag³

Affiliations

¹ Klinik für Gastroenterologie und Hepatologie, München Klinik Neuperlach, Munich, Germany.
² II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
³ UniversitätsSpital Zürich, Klinik für Gastroenterologie und Hepatologie, Raemistrasse 100, Zurich 8091, Switzerland.

Abstract

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with lumen-apposing metal stents (LAMS) appears to be a promising intervention in management of gastroduodenal out obstruction (GOO), particularly for patients for whom surgery is high risk or in a palliative setting. This study aimed to evaluate the technical feasibility, procedure-associated adverse events (AEs), and clinical outcome of direct "free hand" EUS-GE. Patients and methods This retrospective two-center study included patients who underwent direct "free hand" EUS-GE (April 2017 to March 2021) investigating technical success (correctly placed LAMS), clinical outcome (successful oral nutrition), and management of procedure-associated AEs. "Free hand" was defined as the use of the electrocautery enhanced stent delivery system alone without additional guidewire-assistance for EUS-GE creation. Results Forty-five patients (58 % women/42 % men; mean age 65 years) with malignant (n = 39), benign (n = 4) or unclear (n = 2) GOO underwent direct "free hand" EUS-GE. The technical success rate was 98 % (44/45). Of the patients, 95% (42/44) had less vomiting and increased ability to tolerate oral food intake after the intervention. In one patient, a second EUS-GE was necessary to achieve sufficient clinical improvement. Procedure-associated AEs were observed in 24 % (11/45) of cases including stent misplacement (n = 7), leakage (n = 1), development of a gastrojejunocolic fistula (n = 1), and bleeding (n = 2), which could be all managed endoscopically. Conclusions Direct EUS-GE has a favorable risk-benefit profile for patients with GOO, showing high technical success rates, manageable AEs, and rapid symptom relief.

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