Published online: 2020-08-31

Original article

Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

Authors Janine B. Kastelijn1,LeonM.G.Moons1, Francisco J. Garcia-Alonso2, Manuel Pérez-Miranda2, Viliam Masaryk3,Uwe Will3,IlariaTarantino4, Hendrik M. van Dullemen5, Rina Bijlsma6, Jan-Werner Poley7,MatthijsP.Schwartz8,FrankP. Vleggaar1

Institutions Fax: +0031887550724 1 Department of Gastroenterology and Hepatology, [email protected] University Medical Center Utrecht, Utrecht, The Netherlands 2 Department of Gastroenterology and Hepatology, ABSTRACT Hospital Universitario Rio Hortega, Valladolid, Spain Background and study aims Endoscopic ultrasound- 3 Department of Gastroenterology and General Internal guided gastroenterostomy (EUS-GE) with a lumen-appos- Medicine, SRH Wald-Klinikum, Gera, Germany ing metal stent (LAMS) is a novel, minimally invasive tech- 4 Gastroenterology and Unit, Mediterranean nique in the palliative treatment of malignant gastric outlet Institute for Transplantation and Advanced Specialized obstruction (GOO). Several studies have demonstrated fea- Therapies (IsMeTT), Palermo, Italy sibility and safety of EUS-GE, but evidence on long-term 5 Department of Gastroenterology and Hepatology, durability is limited. The aim of this study was to evaluate University Medical Center Groningen, Groningen, The patency of EUS-GE in treatment of malignant GOO. Netherlands Patients and Methods An international multicenter study

6 Department of Gastroenterology and Hepatology, was performed in seven centers in four European countries. Martini Hospital Groningen, Groningen, The Patients who underwent EUS-GE with a LAMS between Netherlands March 2015 and March 2019 for palliative treatment of 7 Department of Gastroenterology and Hepatology, symptomatic malignant GOO were included retrospective- Erasmus University Medical Center, Rotterdam, The ly. Our main outcome was recurrent obstruction due to Netherlands LAMS dysfunction; other outcomes of interest were techni- 8 Department of Gastroenterology and Hepatology, cal success, clinical success, adverse events (AEs), and sur- Meander Medical Center, Amersfoort, The Netherlands vival. Results A total of 45 patients (mean age 69.9±12.3 years submitted 25.2.2020 and 48.9% male) were included. Median duration of follow- accepted after revision 28.5.2020 up was 59 days (interquartile range [IQR] 41–128). Recur- rent obstruction occurred in two patients (6.1%), after 33 Bibliography and 283 days of follow-up. Technical success was achieved DOI https://doi.org/10.1055/a-1214-5659 | in 39 patients (86.7%). Clinical success was achieved in 33 – Endoscopy International Open 2020; 08: E1194 E1201 patients (73.3%). AEs occurred in 12 patients (26.7%), of © Georg Thieme Verlag KG Stuttgart · New York which five were fatal. Median overall survival was 57 days eISSN 2196-9736 (IQR 32–114). Conclusions EUS-GE showed a low rate of recurrent ob- Corresponding author struction. The relatively high number of fatal AEs under- Prof. Dr. F.P. Vleggaar, Department of Gastroenterology and scores the importance of careful implementation of EUS- Hepatology, University Medical Center Utrecht, P.O. Box GE in clinical practice. 85500, 3508 GA, Utrecht, The Netherlands.

E1194 Kastelijn Janine B et al. Patency of endoscopic… Endoscopy International Open 2020; 08: E1194–E1201 Introduction Invited European centres with LAMS expertise Malignant gastric outlet obstruction (GOO) can occur in up to (n=26) 20% of patients with advanced or metastatic malignancies lo- cated in the distal and peri-pancreatic region [1]. Ac- Declined invitation (n = 14) companying obstructive symptoms such as vomiting and nau- ▪ No response (n = 7) sea are a burden to patients and quickly lead to malnutrition ▪ Not performing EUS-GE (n = 6) ▪ Participation in another and poor performance status [2]. Given i