Clin Endosc.  2020 Sep;53(5):510-518. 10.5946/ce.2020.151.

Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction

• Tonozuka R
• Tsuchiya T
• Mukai S
• Nagakawa Y
• Itoi T

• KMID: 2507583
• DOI: http://doi.org/10.5946/ce.2020.151

Abstract

Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality of life. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent (LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GE technique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslim endoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS have shown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studies comparing EUS-GE and surgical gastrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, with a lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.

Keyword

Duodenal obstruction; Endosonography; Gastric bypass; Gastric outlet obstruction; Gastroenterostomy

Figure

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  Fig. 1. Endoscopic ultrasonography (EUS)-guided gastroenterostomy techniques. (A) Direct technique. (B) Balloon-assisted technique. (C) EUS-guided balloon-occluded gastrojejunostomy bypass. (D) Rendezvous guidewire technique. (E) Retrograde deployment technique. LAMS, lumen-apposing self-expandable metal stent.

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  Fig. 2. Endoscopic ultrasonography-guided balloon-occluded gastrojejunostomy bypass. (A) Guidewire advancement across the stricture site into the jejunum. (B) Insertion of the special double‐balloon tube. (C) Inflation of the double balloon. (D) Injection of liquids into the target jejunum to induce distension. (E) Deployment of the lumen-apposing self-expandable metal stent.

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