EUS-guided gastroenterostomy: the first U.S. clinical experience (with video)

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Surgical Oncology

Background:

• Gastric outlet obstruction (GOO) presents treatment challenges with current methods like self-expandable metal stents and surgical gastrojejunostomy.
• Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an emerging technique offering potential for long-term patency and reduced morbidity.
• EUS-GE avoids risks associated with traditional methods, such as tumor ingrowth/overgrowth and surgical complications.

Purpose of the Study:

• To evaluate the initial U.S. clinical experience with EUS-GE for GOO treatment.
• To assess the technical success, clinical success, and safety profile of EUS-GE.
• To describe the technical aspects of performing EUS-GE.

Main Methods:

• Retrospective analysis of 10 patients undergoing EUS-GE at two tertiary-care centers.
• Procedures utilized direct EUS-GE or balloon-assisted EUS-GE techniques.
• Technical success defined by stent positioning and deployment; clinical success by tolerance of oral intake.

Main Results:

• 90% technical success rate (9/10 patients) across both direct and balloon-assisted methods.
• 100% clinical success rate (9/9 patients) with resumption of oral intake, including solid diets for most.
• No procedure-related adverse events observed; mean hospital stay was 2.2 days.

Conclusions:

• EUS-GE demonstrates potential as a safe and effective treatment for benign and malignant GOO.
• The technique offers a promising alternative to conventional therapies for GOO.
• Further validation through prospective, multicenter trials is recommended.