Endoscopy 2021; 53(S 01): S45-S46
DOI: 10.1055/s-0041-1724367
Abstracts | ESGE Days
ESGE Days 2021 Oral presentations
Friday, 26 March 2021 12:00 – 12:45 EUS gastroenterostomy: A new gold standard for managing gastric outlet obstruction? Room 5

Eus-Guided Gastroenterostomy (EUS-GE) For Gastric Outlet Obstruction (GOO) With A Lumen-Apposing Metal Stent (LAMS): Prospective Multicenter Procedural Standardization Of The Parallel Enteral Catheter (PEC) Method

C Chavarría
1   Hospital Universitario Río Hortega, Gastroenterology, Valladolid, Spain
,
V Martín-Álvarez
1   Hospital Universitario Río Hortega, Gastroenterology, Valladolid, Spain
,
JR Aparicio
2   Hospital General Universitario de Alicante, Gastroenterology, Alicante, Spain
,
JC Subtil
3   Clínica Universitaria de Navarra, Gastroenterology, Navarra, Spain
,
FJ Garcia Alonso
1   Hospital Universitario Río Hortega, Gastroenterology, Valladolid, Spain
,
JJ Vila
4   Complejo Hospitalario de Navarra, Gastroenterology, Pamplona, Spain
,
B Martínez-Moreno
2   Hospital General Universitario de Alicante, Gastroenterology, Alicante, Spain
,
V Busto Bea
4   Complejo Hospitalario de Navarra, Gastroenterology, Pamplona, Spain
,
C de la Serna-Higuera
1   Hospital Universitario Río Hortega, Gastroenterology, Valladolid, Spain
,
M Perez-Miranda
1   Hospital Universitario Río Hortega, Gastroenterology, Valladolid, Spain
› Author Affiliations
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Aims Several EUS-GE techniques are available. Fluid instillation into the small bowel using a nasobiliary drain as a PEC during transgastric LAMS insertion under EUS is simple but not yet standardized. We aimed at standardizing the PEC method for EUS-GE.

Methods Prospective IRB-approved multicenter study including consecutive consenting patients with unresectable malignant GOO undergoing primary EUS-GE between August 2019-November 2020. The PEC method involves 4 steps predefined as essential: 1) Over-the-wire, through-the-scope 7-8.5F nasobiliary drain placement distal to the stricture; 2) Over-the-catheter endoscope exchange with parallel echoendoscope gastric intubation; 3) Small bowel distention via PEC fluid instillation and targeting under EUS with fluoroscopy; 4) free-hand cautery-enhanced LAMS placement. Variables related to essential steps included procedure time, injected fluid volume and targeted small bowel diameter. Variations in non-essential steps were recorded and the dominant strategy defined. Adverse events (AE) were graded per ASGE. Clinical success defined as GOO Scoring System ≥ 2 at 30 days.

Results Six endoscopists performed EUS-GE in 38 patients: 53 % male; median (IQR) age 77.3 (65.3-84.4) years. Overall technical success was achieved in 37 (97.4 %) with a median (IQR) procedure duration of 24 (17.5-37.1)-minutes. The failed case resulted from small bowel misidentification and subsequent gastro-colostomy requiring endoscopic LAMS removal and clip-closure one week later (moderately severe AE). Stepwise technical success was obtained in all 4 essential steps of the PEC method by all operators in all patients, except step 3 in the failed case (99.3 % stepwise technical success). Median (IQR) instilled fluid volume was 415 (240-530)-ml and median (IQR) targeted small bowel diameter was 27 (22-30)-mm. Variations in nonessential steps across operators are summarized in Table-1.

Tab. 1

Dominant Strategy

Variation 1

Variation 2

Instilled Fluid Single = water or SS Dual = SS + MB Triple = SS + MB + contrast

Triple (78.9 %)

Single (7.9 %)

Dual (13.2 %)

Instillation Method

Pump (57.9 %)

Syringe (31.6 %)

Water tap adaptor (10.5 %)

LAMS diameter

20-mm (68.4 %)

15-mm (31.6 %)

N/A.

LAMS balloon dilation

No (71.1 %)

Yes (28.9 %)

N/A.

Conclusions When prospectively assessed, the PEC method for EUS-GE was consistently reproducible across operators with varying levels of experience and associated with high technical success rates and relatively short procedure times.

Citation: Chavarría C, Martín-Álvarez V, Aparicio JR et al. OP108 EUS-GUIDED GASTROENTEROSTOMY (EUS-GE) FOR GASTRIC OUTLET OBSTRUCTION (GOO) WITH A LUMEN-APPOSING METAL STENT (LAMS): PROSPECTIVE MULTICENTER PROCEDURAL STANDARDIZATION OF THE PARALLEL ENTERAL CATHETER (PEC) METHOD. Endoscopy 2021; 53: S45.



Publication History

Article published online:
19 March 2021

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