Clinical Review of EUS-guided Gastroenterostomy (EUS-GE)

Ana Y. Carbajo, Michel Kahaleh, Amy Tyberg

Research output: Contribution to journalReview article

Abstract

Gastric outlet obstruction (GOO) refers to mechanical obstruction of the distal stomach or proximal duodenum and it is associated with a significant decrease in quality of life. Surgical gastrojejunostomy and self-expandable metal stents were the traditional treatment for GOO. Recently, endoscopic ultrasound guided gastroenterostomy (EUS-GE) has emerged as a third therapeutic option for patients with GOO. Most EUS-GE techniques utilize the placement of a lumen-apposing metal stent under echoendoscopy but differ in the method of localizing the jejunal loop prior to EUS puncture. Data supporting EUS-GE have been promising. Case series including 10 or more cases showed the technical success rate to be approximately 90%. Clinical success is achieved in approximately 85-90% and a less than 18% risk of adverse events is reported. EUS-GE was associated with a lower recurrence of GOO and need for re-intervention when compared to enteral stenting. In addition, EUS-GE shows significantly fewer adverse events compared with surgical gastrojejunostomy. In conclusion, EUS-GE provides symptom relief without the risks of surgical intervention and the limited patency of enteral SEMS placement. EUS-GE is an exciting new option in the management of GOO. Despite the excellent results, randomized studies comparing these different modalities of treatment for GOO are needed before EUS-GE can be accepted as standard of care.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of Clinical Gastroenterology
Volume54
Issue number1
DOIs
StatePublished - Jan 1 2020

Fingerprint

Gastroenterostomy
Gastric Outlet Obstruction
Gastric Bypass
Small Intestine
Standard of Care
Duodenum
Punctures
Stents
Stomach
Therapeutics
Metals
Quality of Life
Recurrence

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Keywords

  • EUS-guided gastrojejunostomy
  • gastric outlet obstruction
  • lumen-apposing metal stent
  • therapeutic endoscopic ultrasound

Cite this

@article{086774bad4f54b719d34bbdd63ec7ade,
title = "Clinical Review of EUS-guided Gastroenterostomy (EUS-GE)",
abstract = "Gastric outlet obstruction (GOO) refers to mechanical obstruction of the distal stomach or proximal duodenum and it is associated with a significant decrease in quality of life. Surgical gastrojejunostomy and self-expandable metal stents were the traditional treatment for GOO. Recently, endoscopic ultrasound guided gastroenterostomy (EUS-GE) has emerged as a third therapeutic option for patients with GOO. Most EUS-GE techniques utilize the placement of a lumen-apposing metal stent under echoendoscopy but differ in the method of localizing the jejunal loop prior to EUS puncture. Data supporting EUS-GE have been promising. Case series including 10 or more cases showed the technical success rate to be approximately 90{\%}. Clinical success is achieved in approximately 85-90{\%} and a less than 18{\%} risk of adverse events is reported. EUS-GE was associated with a lower recurrence of GOO and need for re-intervention when compared to enteral stenting. In addition, EUS-GE shows significantly fewer adverse events compared with surgical gastrojejunostomy. In conclusion, EUS-GE provides symptom relief without the risks of surgical intervention and the limited patency of enteral SEMS placement. EUS-GE is an exciting new option in the management of GOO. Despite the excellent results, randomized studies comparing these different modalities of treatment for GOO are needed before EUS-GE can be accepted as standard of care.",
keywords = "EUS-guided gastrojejunostomy, gastric outlet obstruction, lumen-apposing metal stent, therapeutic endoscopic ultrasound",
author = "Carbajo, {Ana Y.} and Michel Kahaleh and Amy Tyberg",
year = "2020",
month = "1",
day = "1",
doi = "10.1097/MCG.0000000000001262",
language = "English (US)",
volume = "54",
pages = "1--7",
journal = "Journal of Clinical Gastroenterology",
issn = "0192-0790",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

Clinical Review of EUS-guided Gastroenterostomy (EUS-GE). / Carbajo, Ana Y.; Kahaleh, Michel; Tyberg, Amy.

In: Journal of Clinical Gastroenterology, Vol. 54, No. 1, 01.01.2020, p. 1-7.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Clinical Review of EUS-guided Gastroenterostomy (EUS-GE)

AU - Carbajo, Ana Y.

AU - Kahaleh, Michel

AU - Tyberg, Amy

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Gastric outlet obstruction (GOO) refers to mechanical obstruction of the distal stomach or proximal duodenum and it is associated with a significant decrease in quality of life. Surgical gastrojejunostomy and self-expandable metal stents were the traditional treatment for GOO. Recently, endoscopic ultrasound guided gastroenterostomy (EUS-GE) has emerged as a third therapeutic option for patients with GOO. Most EUS-GE techniques utilize the placement of a lumen-apposing metal stent under echoendoscopy but differ in the method of localizing the jejunal loop prior to EUS puncture. Data supporting EUS-GE have been promising. Case series including 10 or more cases showed the technical success rate to be approximately 90%. Clinical success is achieved in approximately 85-90% and a less than 18% risk of adverse events is reported. EUS-GE was associated with a lower recurrence of GOO and need for re-intervention when compared to enteral stenting. In addition, EUS-GE shows significantly fewer adverse events compared with surgical gastrojejunostomy. In conclusion, EUS-GE provides symptom relief without the risks of surgical intervention and the limited patency of enteral SEMS placement. EUS-GE is an exciting new option in the management of GOO. Despite the excellent results, randomized studies comparing these different modalities of treatment for GOO are needed before EUS-GE can be accepted as standard of care.

AB - Gastric outlet obstruction (GOO) refers to mechanical obstruction of the distal stomach or proximal duodenum and it is associated with a significant decrease in quality of life. Surgical gastrojejunostomy and self-expandable metal stents were the traditional treatment for GOO. Recently, endoscopic ultrasound guided gastroenterostomy (EUS-GE) has emerged as a third therapeutic option for patients with GOO. Most EUS-GE techniques utilize the placement of a lumen-apposing metal stent under echoendoscopy but differ in the method of localizing the jejunal loop prior to EUS puncture. Data supporting EUS-GE have been promising. Case series including 10 or more cases showed the technical success rate to be approximately 90%. Clinical success is achieved in approximately 85-90% and a less than 18% risk of adverse events is reported. EUS-GE was associated with a lower recurrence of GOO and need for re-intervention when compared to enteral stenting. In addition, EUS-GE shows significantly fewer adverse events compared with surgical gastrojejunostomy. In conclusion, EUS-GE provides symptom relief without the risks of surgical intervention and the limited patency of enteral SEMS placement. EUS-GE is an exciting new option in the management of GOO. Despite the excellent results, randomized studies comparing these different modalities of treatment for GOO are needed before EUS-GE can be accepted as standard of care.

KW - EUS-guided gastrojejunostomy

KW - gastric outlet obstruction

KW - lumen-apposing metal stent

KW - therapeutic endoscopic ultrasound

UR - http://www.scopus.com/inward/record.url?scp=85072644034&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072644034&partnerID=8YFLogxK

U2 - 10.1097/MCG.0000000000001262

DO - 10.1097/MCG.0000000000001262

M3 - Review article

C2 - 31567785

AN - SCOPUS:85072644034

VL - 54

SP - 1

EP - 7

JO - Journal of Clinical Gastroenterology

JF - Journal of Clinical Gastroenterology

SN - 0192-0790

IS - 1

ER -