EUS-Guided Gastro-Jejunostomy: Is It Ready for Prime Time? 21 Aug 2021 15:36 15:48

EUS-Guided Gastro-Jejunostomy: Is It Ready for Prime Time? 21 Aug 2021 15:36 15:48

(12 mins)
Takao Itoi Speaker
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Gastric outlet obstruction (GOO) can be caused by peri-ampullary malignancies and often leads to a reduction in quality of life of the patient. Recently, endoscopic ultrasonography (EUS)-guided gastroenterostomy (EUS-GE) using lumen-apposing self-expandable metal stent (LAMS) has emerged expecting minimally invasive and durable endoscopic treatment. The techniques of EUS-GE include three types of EUS-GE: (i) direct technique; (ii) assisted device techniques such as balloon catheter, nasobiliary drain and ultraslim endoscope; and (iii) EUS-guided double balloon-occluded gastrojejunostomy bypass (EPASS). Previous reports of EUS-GE with LAMS showed the technical and clinical success rates, regardless of the technique and etiology, are 87-100 % and 84-100 %, respectively. Comparative trials of EUS-GE and surgical gastrojejunostomy (SGJ) showed not inferior comparable success rate was attained in the EUS-GE to in the SGJ, with lower rate of early adverse events, the comparable rate of the reintervention and cost benefit. In comparison between EUS-GE and endoscopic enteral stent placement (EES), comparable technical success rate and higher initial clinical success was attained in the EUS-GE than in the EES, with lower rate of stent failure requiring reintervention. Although the further improvement of devices, establishment of the techniques and randomized controlled trials with SGJ or EES are needed, EUS-GE is expected to become a standard treatment for GOO in near future.

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