Bachir Ghandour1, Michael Bejjani1, Shayan S Irani2, Reem Z Sharaiha3, Thomas E Kowalski4, Douglas K Pleskow5, Khanh Do-Cong Pham6, Andrea A Anderloni7, Belen Martinez-Moreno8, Harshit S Khara9, Lionel S D'Souza10, Michael Lajin11, Bharat Paranandi12, Jose Carlos Subtil13, Carlo Fabbri14, Tobias Weber15, Marc Barthet16, Mouen A Khashab1. 1. Johns Hopkins Medicine, Baltimore, Maryland, USA. 2. Virginia Mason Medical Center, Seattle, Washington, USA. 3. Weill Cornell Medicine, New York, New York, USA. 4. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. 5. Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 6. Department of Medicine, Haukeland University Hospital, Bergen, Norway. 7. Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy. 8. Hospital General Universitari d'Alacante, Alicante, Communidad Valenciana, Spain. 9. Geisinger Health, Danville, Pennsylvania, USA. 10. Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA. 11. Sharp Grossmont Hospital, La Mesa, California, USA. 12. Leeds Teaching Hospitals NHS Trust, Leeds, UK. 13. Clinica Universidad de Navarra, Pamplona, Navarra, Spain. 14. Gastroneterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forli-Cesena, Italy. 15. Universitatsklinikum Augsburg, Augsburg, Bayern, Germany. 16. Service d'Hépato-gastroentérologie, Hôpital Nord, Marseille, France.
Abstract
BACKGROUND AND AIMS: Stent misdeployment (SM) has hindered the dissemination of EUS-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction (GOO) management. We aimed to provide a classification system for SM during EUS-GE and study clinical outcomes and management accordingly. METHODS: This is a retrospective study involving 16 tertiary care centers (8 in the United States, 8 in Europe) from March 2015 to December 2020. Patients who developed SM during EUS-GE for GOO were included. We propose classifying SM into 4 types. The primary outcome was rate and severity of SM (per American Society for Gastrointestinal Endoscopy lexicon), whereas secondary outcomes were clinical outcomes and management of dislodgement according to the SM classification type, in addition to salvage management of GOO after SM. RESULTS: From 467 EUS-GEs performed for GOO during the study period, SM occurred in 46 patients (9.85%). Most SMs (73.2%) occurred during the first 13 EUS-GE cases by the performing operators. SM was graded as mild (n = 28, 60.9%), moderate (n = 11, 23.9%), severe (n = 6, 13.0%), or fatal (n = 1, 2.2%), with 5 patients (10.9%) requiring surgical intervention. Type I SM was the most common (n = 29, 63.1%), followed by type II (n = 14, 30.4%), type IV (n = 2, 4.3%), and type III (n = 1, 2.2%). Type I SM was more frequently rated as mild compared with type II SM (75.9% vs 42.9%, P = .04) despite an equivalent rate of surgical repair (10.3% vs 7.1%, P = .7). Overall, 4 patients (8.7%) required an intensive care unit stay (median, 2.5 days). The median length of stay was 4 days after SM. CONCLUSIONS: Although SM is not infrequent during EUS-GE, most are type I, mild/moderate in severity, and can be managed endoscopically with a surgical intervention rate of approximately 11%.
BACKGROUND AND AIMS: Stent misdeployment (SM) has hindered the dissemination of EUS-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction (GOO) management. We aimed to provide a classification system for SM during EUS-GE and study clinical outcomes and management accordingly. METHODS: This is a retrospective study involving 16 tertiary care centers (8 in the United States, 8 in Europe) from March 2015 to December 2020. Patients who developed SM during EUS-GE for GOO were included. We propose classifying SM into 4 types. The primary outcome was rate and severity of SM (per American Society for Gastrointestinal Endoscopy lexicon), whereas secondary outcomes were clinical outcomes and management of dislodgement according to the SM classification type, in addition to salvage management of GOO after SM. RESULTS: From 467 EUS-GEs performed for GOO during the study period, SM occurred in 46 patients (9.85%). Most SMs (73.2%) occurred during the first 13 EUS-GE cases by the performing operators. SM was graded as mild (n = 28, 60.9%), moderate (n = 11, 23.9%), severe (n = 6, 13.0%), or fatal (n = 1, 2.2%), with 5 patients (10.9%) requiring surgical intervention. Type I SM was the most common (n = 29, 63.1%), followed by type II (n = 14, 30.4%), type IV (n = 2, 4.3%), and type III (n = 1, 2.2%). Type I SM was more frequently rated as mild compared with type II SM (75.9% vs 42.9%, P = .04) despite an equivalent rate of surgical repair (10.3% vs 7.1%, P = .7). Overall, 4 patients (8.7%) required an intensive care unit stay (median, 2.5 days). The median length of stay was 4 days after SM. CONCLUSIONS: Although SM is not infrequent during EUS-GE, most are type I, mild/moderate in severity, and can be managed endoscopically with a surgical intervention rate of approximately 11%.
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