Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience

Abstract

Background: Surgical gastrojejunostomy and enteral self-expanding metal stents are efficacious for the management of gastric outlet obstruction but limited by high complication rates and short-term efficacy. Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is a novel alternative option.

Patients and methods: Patients who underwent EUS-GJ between March 2014 and September 2015 as part of a prospective multicenter registry at four academic centers in two countries were included. Technical success was defined as successful placement of a gastrojejunal lumen-apposing metal stent. Clinical success was defined as the ability of the patient to tolerate an oral diet. Post-procedural adverse events were recorded.

Results: The study included 26 patients, of whom 11 (42 %) were male. Technical success was achieved in 24 patients (92 %). Clinical success was achieved in 22 patients (85 %). Of the 4 patients in whom clinical success was not achieved, 2 had persistent nausea and vomiting despite a patent EUS-GJ and required enteral feeding for nutrition, 1 died before the initiation of an oral diet, and 1 underwent surgery for suspected perforation. Adverse events, including peritonitis, bleeding, and surgery, occurred in 3 patients (11.5 %).

Conclusion: EUS-GJ is an emerging procedure that has efficacy and safety comparable with those of current therapies and should hold a place as a new minimally invasive option for patients with gastric outlet obstruction. Clinical trial identification number: NCT01522573.

Conflict of interest statement

Competing interests: Dr. Michel Kahaleh has received grant support from Boston Scientific, Fujinon, EMcison, Xlumena, W. L. Gore & Associates, Mauna Kea Technologies, Apollo Endosurgery, Cook Endoscopy, Aspire Bariatrics, GI Dynamics, Olympus, NinePoint Medical, Merit Medical, and MI Technologies. He is a consultant for Boston Scientific, Xlumena, Concordia Laboratories, and Mauna Kea Technologies. None of the other authors has any conflicts of interest to report.

Figures

Fig. 1

Fluoroscopic visualization of a biliary extraction balloon inflated within the jejunum.

Fig. 2

Endosonographic view of the inflated biliary extraction balloon.

Fig. 3

Coiled guidewire within the targeted jejunal loop.

Fig. 4

Endoscopic view of a deployed gastrojejunal lumen-apposing metal stent.

Fig. 5

Dilation of a deployed lumen-apposing metal stent to its diameter.

Fig. 6

Coiled guidewire in the targeted jejunal loop, grasped by forceps. through an ultra-slim scope in the jejunum.

Fig. 7

Direct endoscopic ultrasound puncture of a water-distended jejunal loop.