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

• Published in: Gastrointestinal endoscopy Vol. 87; no. 5; pp. 1215 - 1221
• Main Authors: Chen, Yen-I, Kunda, Rastislav, Storm, Andrew C., Aridi, Hanaa Dakour, Thompson, Christopher C., Nieto, Jose, James, Theodore, Irani, Shayan, Bukhari, Majidah, Gutierrez, Olaya Brewer, Agarwal, Amol, Fayad, Lea, Moran, Robert, Alammar, Nuha, Sanaei, Omid, Canto, Marcia I., Singh, Vikesh K., Baron, Todd H., Khashab, Mouen A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2018
• Subjects: LAMS; EUS-GE; BAGE; DGE; AE; GOO
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2017.07.030

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.
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).
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.
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.