Endoscopic ultrasound-guided gastrojejunostomy with wire endoscopic simplified technique: Move towards benign indications (with video)

IF 5 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2024-09-10 DOI:10.1111/den.14895

Jean-Michel Gonzalez, Sohaib Ouazzani, Geoffroy Vanbiervliet, Mohamed Gasmi, Marc Barthet

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引用次数: 0

Abstract

Objectives

Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is an alternative to duodenal stenting and surgical GJ (SGGJ) in malignant gastric outlet obstruction (MGOO). European Society of Gastrointestinal Endoscopy guidelines restricted EUS-GJ for MGOO only, because of misdeployment. The aim was to evaluate its outcomes focusing on benign indications.

Methods

This was a retrospective study conducted from 2016 to 2023 in a tertiary center. Patients included had malignant or benign GOO indicated for EUS-GJ. Techniques were the direct approach until August 2021, and the wire endoscopic simplified technique (WEST) afterwards. The main objective was to compare outcomes in benign vs. MGOO. Secondary end-points were technical success, adverse events rates, and describing the evolution of techniques and indications.

Results

In all, 87 patients were included, 46 men, mean age 66 ± 16.2 years. Indications were malignant in 60.1% and benign in 39.1%. The EUS-GJ technique was direct in 33 patients (37.9%) and WEST in 54 (62.1%). No difference was found in terms of technical, clinical, or adverse events rates. The initial technical success rate was 88.5%. The final technical and clinical success rates were 96.6% and 94.25%, respectively. In the last year, benign exceeded malignant indications (70.4% vs. 29.6%, P < 0.05). Seven misdeployments occurred, six being addressed with the rescue technique. The misdeployment rate was significantly decreased using the WEST approach compared to the direct one: 3.7% vs. 18% (P < 0.05). The severe postoperative adverse events rate was 2.3%.

Conclusion

This study demonstrated similar outcomes of EUS-GJ between benign and MGOO, with a decreasing misdeployment rate (<4%) applying WEST. This represents an additional step towards recommending EUS-GJ in benign indications.

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内窥镜超声引导下的胃空肠吻合术与线内窥镜简化技术：向良性适应症发展（附视频）

目的内镜超声引导下胃空肠吻合术（EUS-GJ）是恶性胃出口梗阻（MGOO）十二指肠支架植入术和外科胃空肠吻合术（SGGJ）的替代方法。欧洲消化内镜学会的指南规定，EUS-GJ 只能用于 MGOO，因为会出现误操作。方法这是一项回顾性研究，于 2016 年至 2023 年在一家三级中心进行。纳入的患者有恶性或良性 GOO，均有 EUS-GJ 适应症。2021年8月前采用直接方法，2021年8月后采用线内镜简化技术（WEST）。主要目的是比较良性与恶性GOO的治疗效果。次要终点是技术成功率、不良事件发生率，以及描述技术和适应症的演变。60.1%的适应症为恶性，39.1%为良性。33例患者（37.9%）采用直接EUS-GJ技术，54例患者（62.1%）采用WEST技术。在技术、临床和不良事件发生率方面没有发现差异。最初的技术成功率为 88.5%。最终的技术和临床成功率分别为 96.6% 和 94.25%。去年，良性适应症超过了恶性适应症（70.4% 对 29.6%，P <0.05）。发生了七次错误部署，其中六次是通过抢救技术解决的。与直接方法相比，WEST方法的误置率明显降低：3.7%对18%（P< 0.05）。结论这项研究表明，良性和 MGOO 的 EUS-GJ 结果相似，采用 WEST 方法的误切率（<4%）有所下降。这表明在良性适应症中推荐使用 EUS-GJ 又迈进了一步。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.