Format

Send to

Choose Destination
Gastrointest Endosc. 2018 May;87(5):1215-1221. doi: 10.1016/j.gie.2017.07.030. Epub 2017 Jul 24.

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

Author information

1
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
2
Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
3
Division of Gastroenterology, Hepatology and endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
4
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
5
Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida, USA.
6
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
7
Division of Gastroenterology and Hepatology, Virgina Mason Medical Center, Seattle, Washington, USA.

Abstract

BACKGROUND:

EUS-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 was to compare the direct with the balloon-assisted modality while further defining the role of EUS-GE in GOO.

METHODS:

This multicenter, retrospective study involved consecutive patients who underwent EUS-GE with the direct or balloon-assisted technique for GOO (January 2014 to October 2016). The primary outcome was technical success. Secondary outcomes were success (ability to tolerate at least a full fluid diet), procedure time, and rate/severity of adverse events (AEs).

RESULTS:

A total of 74 patients (44.6% women; mean age 63.0 ± 11.7 years) underwent EUS-GE for GOO (direct gastroenterostomy, n = 52; balloon-assisted gastroenterostomy, n = 22). GOO was of malignant and benign etiology in 66.2% and 33.8% of patients, respectively. Technical success was achieved in 94.2% of the direct and 90.9% of the balloon-assisted approach (P = .63). Mean procedure time was shorter with the direct technique (35.7 ± 32.1 minutes vs 89.9 ± 33.3 minutes, P < .001). The clinical success rate was 92.3% for the direct technique and 90.9% for the balloon-assisted modality (P = 1.00), with a mean time to oral intake of 1.32 ± 2.76 days. The AE rate was 6.8% with only 1 severe AE noted. Rate of AEs, postprocedure length of stay, need for reintervention, and survival were similar between the 2 groups.

CONCLUSIONS:

EUS-GE 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 the balloon-assisted approach. Prospective trials are needed to confirm these findings.

PMID:
28750837
DOI:
10.1016/j.gie.2017.07.030
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center