Title |
EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction
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Published in |
Surgical Endoscopy, November 2016
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DOI | 10.1007/s00464-016-5311-1 |
Pubmed ID | |
Authors |
Yen-I Chen, Takao Itoi, Todd H. Baron, Jose Nieto, Yamile Haito-Chavez, Ian S. Grimm, Amr Ismail, Saowanee Ngamruenphong, Majidah Bukhari, Gulara Hajiyeva, Ahmad S. Alawad, Vivek Kumbhari, Mouen A. Khashab |
Abstract |
Endoscopic enteral stenting (ES) in malignant gastric outlet obstruction (GOO) is limited by high rates of stent obstruction. EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers sustained patency without tumor ingrowth/overgrowth. The aim of this study is to compare EUS-GE with ES in terms of (1) symptom recurrence and need for re-intervention, (2) technical success (proper stent positioning as determined via endoscopy and fluoroscopy), (3) clinical success (ability to tolerate oral intake without vomiting), and (4) procedure-related adverse events (AEs). Multicenter retrospective study of all consecutive patients who underwent either EUS-GE at four centers between 2013 and 2015 or ES at one center between 2008 and 2010. A total of 82 patients (mean age 66-years ± 13.5 and 40.2% female) were identified: 30 in EUS-GE and 52 in ES. Technical and clinical success was not significantly different: 86.7% EUS-GE versus 94.2% ES (p = 0.2) and 83.3% EUS-GE versus 67.3% ES (p = 0.12), respectively. Symptom recurrence and need for re-intervention, however, was significantly lower in the EUS-GE group (4.0 vs. 28.6%, (p = 0.015). Post-procedure mean length of hospitalization was comparable at 11.3 days ± 6.6 for EUS-GE versus 9.5 days ± 8.3 for ES (p = 0.3). Rates and severity of AEs (as per the ASGE lexicon) were also similar (16.7 vs. 11.5%, p = 0.5). On multivariable analysis, ES was independently associated with need for re-intervention (OR 12.8, p = 0.027). EUS-GE may be ideal for malignant GOO with comparable effectiveness and safety to ES while being associated with fewer symptom recurrence and requirements for re-intervention. |
X Demographics
Geographical breakdown
Country | Count | As % |
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United States | 1 | 25% |
Unknown | 3 | 75% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 2 | 50% |
Scientists | 1 | 25% |
Science communicators (journalists, bloggers, editors) | 1 | 25% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 65 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Other | 11 | 17% |
Student > Bachelor | 5 | 8% |
Researcher | 5 | 8% |
Student > Postgraduate | 4 | 6% |
Student > Master | 4 | 6% |
Other | 8 | 12% |
Unknown | 28 | 43% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 29 | 45% |
Agricultural and Biological Sciences | 2 | 3% |
Nursing and Health Professions | 1 | 2% |
Engineering | 1 | 2% |
Unknown | 32 | 49% |