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Technical feasibility and clinical success of direct “free hand” EUS-guided gastroenterostomy in patients with gastric outlet obstruction

Background and study aims  Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with lumen-apposing metal stents (LAMS) appears to be a promising intervention in management of gastroduodenal out obstruction (GOO), particularly for patients for whom surgery is high risk or in a palliative setting....

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Autores principales: Fischer, Hanna, Rüther, Katharina, Abdelhafez, Mohamed, Götzberger, Manuela, Dollhopf, Markus, Schlag, Christoph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9576332/
https://www.ncbi.nlm.nih.gov/pubmed/36262515
http://dx.doi.org/10.1055/a-1907-5393
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author Fischer, Hanna
Rüther, Katharina
Abdelhafez, Mohamed
Götzberger, Manuela
Dollhopf, Markus
Schlag, Christoph
author_facet Fischer, Hanna
Rüther, Katharina
Abdelhafez, Mohamed
Götzberger, Manuela
Dollhopf, Markus
Schlag, Christoph
author_sort Fischer, Hanna
collection PubMed
description Background and study aims  Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with lumen-apposing metal stents (LAMS) appears to be a promising intervention in management of gastroduodenal out obstruction (GOO), particularly for patients for whom surgery is high risk or in a palliative setting. This study aimed to evaluate the technical feasibility, procedure-associated adverse events (AEs), and clinical outcome of direct “free hand” EUS-GE. Patients and methods  This retrospective two-center study included patients who underwent direct “free hand” EUS-GE (April 2017 to March 2021) investigating technical success (correctly placed LAMS), clinical outcome (successful oral nutrition), and management of procedure-associated AEs. “Free hand” was defined as the use of the electrocautery enhanced stent delivery system alone without additional guidewire-assistance for EUS-GE creation. Results  Forty-five patients (58 % women/42 % men; mean age 65 years) with malignant (n = 39), benign (n = 4) or unclear (n = 2) GOO underwent direct “free hand” EUS-GE. The technical success rate was 98 % (44/45). Of the patients, 95% (42/44) had less vomiting and increased ability to tolerate oral food intake after the intervention. In one patient, a second EUS-GE was necessary to achieve sufficient clinical improvement. Procedure-associated AEs were observed in 24 % (11/45) of cases including stent misplacement (n = 7), leakage (n = 1), development of a gastrojejunocolic fistula (n = 1), and bleeding (n = 2), which could be all managed endoscopically. Conclusions  Direct EUS-GE has a favorable risk-benefit profile for patients with GOO, showing high technical success rates, manageable AEs, and rapid symptom relief.
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spelling pubmed-95763322022-10-18 Technical feasibility and clinical success of direct “free hand” EUS-guided gastroenterostomy in patients with gastric outlet obstruction Fischer, Hanna Rüther, Katharina Abdelhafez, Mohamed Götzberger, Manuela Dollhopf, Markus Schlag, Christoph Endosc Int Open Background and study aims  Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with lumen-apposing metal stents (LAMS) appears to be a promising intervention in management of gastroduodenal out obstruction (GOO), particularly for patients for whom surgery is high risk or in a palliative setting. This study aimed to evaluate the technical feasibility, procedure-associated adverse events (AEs), and clinical outcome of direct “free hand” EUS-GE. Patients and methods  This retrospective two-center study included patients who underwent direct “free hand” EUS-GE (April 2017 to March 2021) investigating technical success (correctly placed LAMS), clinical outcome (successful oral nutrition), and management of procedure-associated AEs. “Free hand” was defined as the use of the electrocautery enhanced stent delivery system alone without additional guidewire-assistance for EUS-GE creation. Results  Forty-five patients (58 % women/42 % men; mean age 65 years) with malignant (n = 39), benign (n = 4) or unclear (n = 2) GOO underwent direct “free hand” EUS-GE. The technical success rate was 98 % (44/45). Of the patients, 95% (42/44) had less vomiting and increased ability to tolerate oral food intake after the intervention. In one patient, a second EUS-GE was necessary to achieve sufficient clinical improvement. Procedure-associated AEs were observed in 24 % (11/45) of cases including stent misplacement (n = 7), leakage (n = 1), development of a gastrojejunocolic fistula (n = 1), and bleeding (n = 2), which could be all managed endoscopically. Conclusions  Direct EUS-GE has a favorable risk-benefit profile for patients with GOO, showing high technical success rates, manageable AEs, and rapid symptom relief. Georg Thieme Verlag KG 2022-10-17 /pmc/articles/PMC9576332/ /pubmed/36262515 http://dx.doi.org/10.1055/a-1907-5393 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Fischer, Hanna
Rüther, Katharina
Abdelhafez, Mohamed
Götzberger, Manuela
Dollhopf, Markus
Schlag, Christoph
Technical feasibility and clinical success of direct “free hand” EUS-guided gastroenterostomy in patients with gastric outlet obstruction
title Technical feasibility and clinical success of direct “free hand” EUS-guided gastroenterostomy in patients with gastric outlet obstruction
title_full Technical feasibility and clinical success of direct “free hand” EUS-guided gastroenterostomy in patients with gastric outlet obstruction
title_fullStr Technical feasibility and clinical success of direct “free hand” EUS-guided gastroenterostomy in patients with gastric outlet obstruction
title_full_unstemmed Technical feasibility and clinical success of direct “free hand” EUS-guided gastroenterostomy in patients with gastric outlet obstruction
title_short Technical feasibility and clinical success of direct “free hand” EUS-guided gastroenterostomy in patients with gastric outlet obstruction
title_sort technical feasibility and clinical success of direct “free hand” eus-guided gastroenterostomy in patients with gastric outlet obstruction
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9576332/
https://www.ncbi.nlm.nih.gov/pubmed/36262515
http://dx.doi.org/10.1055/a-1907-5393
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