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Dig Endosc. 2017 May;29(4):495-502. doi: 10.1111/den.12794. Epub 2017 Jan 27.

Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017.

Author information

1
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
2
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, USA.
3
Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, USA.
4
Digestive Disease Institute at Virginia Mason Medical Center, Seattle, USA.
5
Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India.
6
Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.

Abstract

Gastric outlet obstruction (GOO) can be caused by benign and malignant diseases and often leads to a reduction in patient quality of life. Lately, endoscopic ultrasonography (EUS)-guided gastroenterostomy (EUS-GE) has emerged. At the present time, there are three types of EUS-GE using lumen-apposing biflanged metal stents (LAMS): (i) direct EUS-GE; (ii) assisted EUS-GE using retrieval/dilating balloon, single balloon overtube, nasobiliary drain and ultraslim endoscope; and (iii) EUS-guided double-balloon-occluded gastrojejunostomy bypass (EPASS). Overall technical success rate is approximately 90% regardless of technique used, although this is based on two retrospective studies only. In the EPASS procedure, the success rate of the one-step procedure was higher than that of the two-step procedure (100% vs 82%). Clinical success was almost uniform when stent placement was technically successful. Although there have been no-stent induced procedural deaths, adverse events were seen in several cases. One technically failed case carried out using balloon-assisted EUS-GE was converted to laparoscopic gastrojejunostomy. Two failed cases in EPASS procedure improved with conservative treatment. In the present review, we show the feasibility and outcomes using novel EUS-GE using LAMS. Clinical prospective trials with comparison to luminal enteral stents and surgical GE are warranted.

KEYWORDS:

anastomosis; endoscopic ultrasonography; endoscopic ultrasonography-guided gastroenterostomy; gastrojejunostomy; lumen-apposing metal stent

PMID:
28032663
DOI:
10.1111/den.12794
[Indexed for MEDLINE]

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