Wei On1, Matthew T Huggett1, Alistair Young2, James Pine2, Andrew M Smith2, Nadeem Tehami3, Ben Maher4, Stephen P Pereira5, Gavin Johnson5, Bharat Paranandi6,7. 1. Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 2. Department of Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 3. Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 4. Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 5. Department of Gastroenterology, University College Hospitals NHS Foundation Trust, London, UK. 6. Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. b.paranandi@nhs.net. 7. St James's University Hospital, 4th Floor, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK. b.paranandi@nhs.net.
Abstract
BACKGROUND: Endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) with lumen apposing metal stents has recently emerged as a viable option, as an alternative to surgical gastrojejunostomy and endoscopic enteral stenting, for managing gastric outlet obstruction (GOO). We aim to perform a retrospective analysis of the efficacy, safety and outcomes of EUS-GJ performed at three tertiary institutions in the United Kingdom. METHODS: Consecutive patients who underwent EUS-GJ between August 2018 and March 2021 were identified from a prospectively maintained database. Data were obtained from interrogation of electronic health records. RESULTS: Twenty five patients (15 males) with a median age of 63 years old (range 29-80) were included for analysis. 88% (22/25) of patients had GOO due to underlying malignant disease. All patients were deemed surgically inoperable or at high surgical risk. Both technical and clinical success were achieved in 92% (23/25) of patients. There was an improvement in the mean Gastric Outlet Obstruction Scoring System scores following a technically successful EUS-GJ (2.52 vs 0.68, p < 0.01). Adverse events occurred in 2/25 patients (8%), both due to stent maldeployment necessitating endoscopic closure of the gastric defect with clips. Long-term follow-up data were available for 21 of 23 patients and the re-intervention rate was 4.8% (1/21) over a median follow-up period of 162 (range 5-474) days. CONCLUSION: EUS-GJ in carefully selected patients is an effective and safe procedure when performed by experienced endoscopists.
BACKGROUND: Endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) with lumen apposing metal stents has recently emerged as a viable option, as an alternative to surgical gastrojejunostomy and endoscopic enteral stenting, for managing gastric outlet obstruction (GOO). We aim to perform a retrospective analysis of the efficacy, safety and outcomes of EUS-GJ performed at three tertiary institutions in the United Kingdom. METHODS: Consecutive patients who underwent EUS-GJ between August 2018 and March 2021 were identified from a prospectively maintained database. Data were obtained from interrogation of electronic health records. RESULTS: Twenty five patients (15 males) with a median age of 63 years old (range 29-80) were included for analysis. 88% (22/25) of patients had GOO due to underlying malignant disease. All patients were deemed surgically inoperable or at high surgical risk. Both technical and clinical success were achieved in 92% (23/25) of patients. There was an improvement in the mean Gastric Outlet Obstruction Scoring System scores following a technically successful EUS-GJ (2.52 vs 0.68, p < 0.01). Adverse events occurred in 2/25 patients (8%), both due to stent maldeployment necessitating endoscopic closure of the gastric defect with clips. Long-term follow-up data were available for 21 of 23 patients and the re-intervention rate was 4.8% (1/21) over a median follow-up period of 162 (range 5-474) days. CONCLUSION: EUS-GJ in carefully selected patients is an effective and safe procedure when performed by experienced endoscopists.
Authors: Manuel Perez-Miranda; Amy Tyberg; Daniel Poletto; Ernesto Toscano; Monica Gaidhane; Amit P Desai; Nikhil A Kumta; Lea Fayad; Jose Nieto; Marc Barthet; Raj Shah; Brian C Brauer; Reem Z Sharaiha; Michel Kahaleh Journal: J Clin Gastroenterol Date: 2017 Nov/Dec Impact factor: 3.062