Michiel Bronswijk1, Giuseppe Vanella2, Hannah van Malenstein3, Wim Laleman3, Joris Jaekers4, Baki Topal4, Freek Daams5, Marc G Besselink6, Paolo Giorgio Arcidiacono2, Rogier P Voermans7, Paul Fockens8, Alberto Larghi9, Roy Lj van Wanrooij10, Schalk van der Merwe3. 1. Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium; Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium. 2. Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3. Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium. 4. Department of Visceral Surgery, University Hospitals Gasthuisberg, KU Leuven, Belgium. 5. Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, The Netherlands. 6. Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands. 7. Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, AGEM institute, Amsterdam, The Netherlands. 8. Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, AGEM institute, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM institute, Amsterdam, The Netherlands. 9. Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome; CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy. 10. Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM institute, Amsterdam, The Netherlands.
Abstract
BACKGROUND AND AIMS: In the management of gastric outlet obstruction (GOO), EUS-guided gastroenterostomy (EUS-GE) seems safe and more effective than enteral stent placement. However, comparisons with laparoscopic gastroenterostomy (L-GE) are scarce. Our aim was to perform a propensity score-matched comparison between EUS-GE and L-GE. METHODS: An international, multicenter, retrospective analysis was performed of consecutive EUS-GE and L-GE procedures in 3 academic centers (Jan 2015 to May 2020), using propensity score-matching in order to minimize selection bias. A standard maximum propensity score difference of 0.1 was applied, also considering underlying disease and oncological staging. RESULTS: Overall, 77 patients were treated with EUS-GE and 48 patients with L-GE. By means of propensity score-matching, 37 patients were allocated to both groups, resulting in 74 (1:1) matched patients. Technical success was achieved in 35 out of 37 EUS-GE-treated patients (94.6%) versus 100% in the L-GE group (p=0.493). Clinical success, defined as eating without vomiting or GOO Scoring System ≥2, was achieved in 97.1% and 89.2%, respectively (p=0.358). Median time to oral intake (1 [IQR 0.3-1.0] vs 3 [IQR 1.0-5.0] days, p<0.001) and median hospital stay (4 [IQR 2-8] vs 8 [IQR 5.5-20] days, p<0.001) were significantly shorter in the EUS-GE group. Overall adverse events (AEs) (2.7% vs 27.0%, p=0.007) and severe AEs (0.0% vs 16.2%, p=0.025) were identified more frequently in the L-GE group. CONCLUSION: For patients with GOO, EUS-GE and L-GE showed almost identical technical and clinical success. However, reduced time to oral intake, shorter median hospital stay, and lower rate of adverse events suggest that the EUS-guided approach might be preferable.
BACKGROUND AND AIMS: In the management of gastric outlet obstruction (GOO), EUS-guided gastroenterostomy (EUS-GE) seems safe and more effective than enteral stent placement. However, comparisons with laparoscopic gastroenterostomy (L-GE) are scarce. Our aim was to perform a propensity score-matched comparison between EUS-GE and L-GE. METHODS: An international, multicenter, retrospective analysis was performed of consecutive EUS-GE and L-GE procedures in 3 academic centers (Jan 2015 to May 2020), using propensity score-matching in order to minimize selection bias. A standard maximum propensity score difference of 0.1 was applied, also considering underlying disease and oncological staging. RESULTS: Overall, 77 patients were treated with EUS-GE and 48 patients with L-GE. By means of propensity score-matching, 37 patients were allocated to both groups, resulting in 74 (1:1) matched patients. Technical success was achieved in 35 out of 37 EUS-GE-treated patients (94.6%) versus 100% in the L-GE group (p=0.493). Clinical success, defined as eating without vomiting or GOO Scoring System ≥2, was achieved in 97.1% and 89.2%, respectively (p=0.358). Median time to oral intake (1 [IQR 0.3-1.0] vs 3 [IQR 1.0-5.0] days, p<0.001) and median hospital stay (4 [IQR 2-8] vs 8 [IQR 5.5-20] days, p<0.001) were significantly shorter in the EUS-GE group. Overall adverse events (AEs) (2.7% vs 27.0%, p=0.007) and severe AEs (0.0% vs 16.2%, p=0.025) were identified more frequently in the L-GE group. CONCLUSION: For patients with GOO, EUS-GE and L-GE showed almost identical technical and clinical success. However, reduced time to oral intake, shorter median hospital stay, and lower rate of adverse events suggest that the EUS-guided approach might be preferable.
Authors: Giuseppe Vanella; Domenico Tamburrino; Gabriele Capurso; Michiel Bronswijk; Michele Reni; Giuseppe Dell'Anna; Stefano Crippa; Schalk Van der Merwe; Massimo Falconi; Paolo Giorgio Arcidiacono Journal: World J Gastroenterol Date: 2022-03-14 Impact factor: 5.742
Authors: Anand Kumar; Saurabh Chandan; Babu P Mohan; Pradeep R Atla; Evin J McCabe; David H Robbins; Arvind J Trindade; Petros C Benias Journal: Endosc Int Open Date: 2022-04-14
Authors: Giuseppe Vanella; Giuseppe Dell'Anna; Michiel Bronswijk; Roy L J van Wanrooij; Gianenrico Rizzatti; Paraskevas Gkolfakis; Alberto Larghi; Schalk van der Merwe; Paolo Giorgio Arcidiacono Journal: Ann Gastroenterol Date: 2022-07-15