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Wang J, Hu JL, Sun SY. Endoscopic ultrasound guided gastroenterostomy: Technical details updates, clinical outcomes, and adverse events. World J Gastrointest Endosc 2023; 15:634-640. [DOI: 10.4253/wjge.v15.i11.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has been transformed from an innovative technique, into a viable alternative to enteral stenting and surgical gastrointestinal anastomosis for patients with gastric outlet obstruction. Even EUS-GE guided ERCP and EUS-guided gastrointestinal anastomosis for the treatment of afferent loop syndrome have been performed, giving patients more less invasive options. However, EUS-GE is still a technically challenging procedure. In order to improve EUS-GE, several techniques have been reported to improve the technical details. With EUS-GE widely performed, more data about EUS-GE’s clinical outcomes have been reported. The aim of the current review is to describe technical details updates, clinical outcomes, and adverse events of EUS-GE.
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Affiliation(s)
- Jian Wang
- Department of Gastroenterology, People's Hospital of Shenyang Economic and Technological Development Zone, Shenyang 110001, Liaoning Province, China
| | - Jin-Long Hu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Si-Yu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Boghossian MB, Funari MP, De Moura DTH, McCarty TR, Sagae VMT, Chen YI, Mendieta PJO, Neto FLP, Bernardo WM, Dos Santos MEL, Chaves FT, Khashab MA, de Moura EGH. EUS-guided gastroenterostomy versus duodenal stent placement and surgical gastrojejunostomy for the palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis. Langenbecks Arch Surg 2021; 406:1803-1817. [PMID: 34121130 DOI: 10.1007/s00423-021-02215-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Malignant gastric outlet obstruction (GOO) is associated with significant morbidity and decreased quality of life, thereby necessitating effective and safe palliative treatment. As such, we sought to compare endoscopic ultrasound-guided gastroenterostomy (EUS-GE) versus duodenal stent (DS) placement and surgical gastrojejunostomy (SGJ) for palliation of malignant GOO. METHODS Searches of electronic databases were performed to identify studies comparing EUS-GE versus DS and/or SGJ for palliative treatment of GOO. Outcomes included technical and clinical success, severe adverse events (SAEs), rate of stent obstruction (including tumor ingrowth), length of hospital stay (LOS), reintervention, and 30-day all-cause mortality. Differences in dichotomous and continuous outcomes were reported as risk difference and mean difference, respectively. RESULTS Seven studies (n = 513 patients) were included. When compared to DS placement, EUS-GE was associated with a higher clinical success, fewer SAEs, decreased stent obstruction, lower rate of tumor ingrowth, and decreased need for reintervention. Compared to SGJ, EUS-GE was associated with a lower technical success; however, LOS was significantly decreased. All other outcomes including clinical success, SAEs, reintervention rate, and 30-day mortality were not significantly different between an EUS-guided versus surgical approach. CONCLUSIONS EUS-GE was associated with significantly improved outcomes compared to DS placement for palliative treatment of malignant GOO. Despite SGJ possessing a higher technical success compared to EUS-GE, LOS was significantly longer with no difference in clinical success or rate of adverse events.
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Affiliation(s)
- Mateus Bond Boghossian
- Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil.
| | - Mateus Pereira Funari
- Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil
| | - Diogo Turiani Hourneaux De Moura
- Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil
| | - Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitor Massaro Takamatsu Sagae
- Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil
| | - Yen-I Chen
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC, Canada
| | - Pastor Joaquín Ortiz Mendieta
- Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil
| | - Fernando Lopes Ponte Neto
- Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil
| | - Marcos Eduardo Lera Dos Santos
- Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil
| | - Filipe Tomishige Chaves
- Rua Isabel Schmidt, Universidade Santo Amaro, 349 - Santo Amaro, São Paulo, SP, 04743-030, Brazil
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil
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