EUS-guided gastrointestinal anastomosis – new possibilities of therapeutic endoscopy

Czech version

Authors: Nosek V.; Pintová J.
Authors‘ workplace: Gastroenterologické oddělení, Nemocnice Jablonec nad Nisou, p. o.
Published in: Gastroent Hepatol 2020; 74(4): 302-310
Category: Clinical and Experimental Gastroenterology: Original Article
doi: https://doi.org/10.14735/amgh2020302

Overview

Introduction: Endosonographic guided gastroenteroanastomosis (EUS-GEA) with lumen apposing metal stents is a novel alternative of treating malignant and benign gastric outlet obstruction (GOO). EUS-GEA can also be used to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy of the upper gastrointestinal tract.

Methods: We performed a retrospective analysis of 25 consecutive patients with endoscopically formed gastrointestinal anastomoses. We separately analyzed 20 patients with GOO and five patients with biliary obstruction and surgically altered anatomy in whom enteroscopy-assisted ERCP had failed. Primarily, we evaluated technical feasibility, clinical efficiency and complications.

Results: In a group of 20 patients with GOO, technical feasibility was 95% (19/20) and clinical efficacy was 94.7% (18/19). There were no early complications. Late complications occurred in three patients (15.8%). Endoscopic reintervention was required in 5.3% of patients (1/19). Sixteen patients had malignant GOO. Ten patients died. The mean time from procedure to death was 92.5 days (32–259). In the group of five patients with surgically altered anatomy, technical feasibility to perform gastrointestinal anastomosis was 100%; it was followed by successful ERCP in 4/5 patients (80%) with no complications.

Conclusion: EUS-GEA can be performed endoscopically with high technical feasibility and clinical efficacy and low need for reintervention. In appropriately selected patients they are a promising alternative to surgical and radiological approaches.

Conflict of Interest: The authors declare that the article/ manuscript complies with ethical standards, patient anonymity has been respected. V. Nosek is a consultant of Boston Scientific company.

Publication Ethics: This article/manuscript has not been published or is currently being submitted for another review. The authors agree to publish their name and e-mail in the published article/manuscript.

Dedication: The article/ manuscript is not supported by a grant nor has it been created with the support of any company.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for bio medical papers.

Keywords:

endosonography – gastrointestinal anastomosis

Sources

1. Shamah SP, Siddiqui UD. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE). In: Adler DG (ed). Interventional endoscopic ultrasound. Springer Nature Switzerland AG 2019: 159–168. doi: 10.1007/978-3-319-97376-0_15.

2. Chen YI, Kunda R, Storm AC et al. EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques. Gastrointest Endosc 2018; 87 (5): 1215–1221. doi: 10.1016/j.gie.2017.07.030.

3. Ghoshal UC, Kumar V. Antroduodenal stenting for malignant gastric outlet obstruction: technique and outcome. J Dig Endosc 2019; 10 (1). doi: 10.4103/jde.JDE_64_18.

4. Khashab M, Alawad AS, Shin EJ et al. Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 2013; 27 (6): 2068–2075. doi: 10.1007/s00464-012-2712-7.

5. Jeurnink SM, Steyerberg EW, van Hooft JE et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71 (3): 490–499 doi: 10.1016/j.gie.2009.09.042.

6. Wang J, Liu X, Wang S et al. Endoscopic ultrasound-guided gastroenterostomy: a promising alternative to surgery. J Transl Int Med 2019; 7 (3): 93–99. doi: 10.2478/jtim-2019-0021.

7. Bukhari M, Kowalski T, Nieto J et al. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc 2018; 88 (3): 486–494. doi: 10.1016/j.gie.2018.04.2356.

8. Pintová J, Procházka R, Nosek V. Endosonograficky navigované drenážní výkony novými metalickými apozičními stenty s elektrokauterizační jednotkou (stent Hot AXIOS) – vlastní soubor 20 pacientů. Gastroent hepatol 2018; 72 (4): 309–316. doi: 10.14735/amgh2018309.

9. Amateau SK, Lim CH, McDonald NM et al. EUS-guided endoscopic gastrointestinal anastomosis with lumen-apposing metal stent: feasibility, safety, and efficacy. Obes Surg 2018; 28 (5): 1445–1451. doi: 10.1007/s11695-018-3171-6.

10. Binmoeller KF, Shah JN. Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study. Endoscopy 2012; 44 (5): 499–503. doi: 10.1055/s-0032-1309382.

11. Itoi T, Itokawa F, Uraoko T et al. Novel EUS-guided gastrojejunostomy technique using a new double-balloon enteric tube and lumen-apposing metal stent (with videos). Gastrointest Endosc 2013; 78 (6): 934–939. doi: 10.1016/j.gie.2013.09.025.

12. Khashab MA, Kumbhari V, Grimm IS et al. EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc 2015; 82 (5): 932–938. doi: 10.1016/j.gie.2015.06.017.

13. Khashab MA, Bukhari M, Baron TH et al. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open 2017; 5 (4): E275–E281. doi: 10.1055/s-0043-101695.

14. Chen YI, Itoi t, Baron TH et al. EUS-guided gastroenterostomy is comparable to metal stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 2017; 31 (7): 2946–2952. doi: 10.1007/s00464-016-5311-1.

15. Kerdsirichairat T, Irani S, Yang J et al. Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction. Endosc Int Open 2019; 7 (2): E144–E150. doi: 10.1055/a-0799-9939.

16. McCarty TR, Garg R, Thompson CC et al. Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7 (11): E1474–E1482. doi: 10.1055/a-0996-8178.

17. Itoi T, Baron TH, Khashab MA et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc 2017; 29 (4): 495–502. doi: 10.1111/den.12794.

Poděkování

Zvláštní poděkování autoři práce adresují prof. Rastislavu Kundovi, M.D., F. a. s.G.E., který nezištně poskytl množství cenných rad při zavádění konceptu EUS navigovaných gastrointestinálních anastomóz na našem pracovišti a osobně přijel provést EUS-GEA v rámci tradičního EUS workshopu v Jablonci nad Nisou v listopadu 2018.