EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques

Publication date: Available online 24 July 2017
Source:Gastrointestinal Endoscopy
Author(s): Yen-I. Chen, Rastislav Kunda, Andrew C. Storm, Hanaa Dakour Aridi, Christopher C. Thompson, Jose Nieto, Ali A. Siddiqui, Theodore James, Shayan Irani, Majidah Bukhari, Olaya Brewer Gutierrez, Amol Agarwal, Lea Fayad, Robert Moran, Nuha Alammar, Omid Sanaei, Marcia I. Canto, Vikesh K. Singh, Todd H. Baron, Mouen A. Khashab
BackgroundEndoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a developing modality in the management of gastric outlet obstruction (GOO) with several technical approaches including the direct and balloon-assisted techniques. The aim of this study is to compare the direct with the balloon-assisted modality while further defining the role of EUS-GE in GOO.MethodsMulticenter, retrospective study involving consecutive patients who underwent EUS gastroenterostomy with the direct or balloon-assisted technique for GOO (January 2014-October 2016). The primary outcome is technical success. Secondary outcomes include clinical success (ability to tolerate at least a full fluid diet), procedure time, and rate/severity of adverse events (AE).ResultsSeventy-seven patients (42.9% female; mean age 63.2 ± 11.5 years) underwent EUS gastroenterostomy for GOO (n=55 DGE and n=22 BAGE). GOO was of malignant and benign etiology in 67.5% and 32.5% of the patients, respectively. Technical success was achieved in 94.5% of the direct and 90.9% of the balloon-assisted approach (p=0.62). Mean procedure time was shorter with the direct technique (35.1±31.2 minutes vs 89.9±33.3 minutes, p<0.001). Clinical success rate was 92.7% for the direct and 90.9% for balloon-assisted modality (p=0.79), with a mean time to oral intake of 1.41±2.75 days. The AE rate was 6.5% with only one severe AE noted. Rate of AE, postprocedure length of stay, need for re-intervention, and survival were similar between the 2 groups.ConclusionEUS gastroenterostomy is effective and safe in the management of GOO. The direct technique may be the preferred method given its shorter procedure time when compared with balloon-assisted approach. Prospective trials are needed to confirm these findings.



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