EUS-guided gastrointestinal anastomosis – new possibilities of therapeutic endoscopy

Česká verzia

Authors: Nosek V.; Pintová J.
Authors place of work: Gastroenterologické oddělení, Nemocnice Jablonec nad Nisou, p. o.
Published in the journal: Gastroent Hepatol 2020; 74(4): 302-310
Category: Clinical and Experimental Gastroenterology: Original Article
doi: https://doi.org/10.14735/amgh2020302

Summary

Introduction: Endosonographic guided gastroenteroanastomosis (EUS-GEA) with lumen apposing metal stents is a novel alternative of treating malignant and benign gastric outlet obstruction (GOO). EUS-GEA can also be used to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy of the upper gastrointestinal tract.

Methods: We performed a retrospective analysis of 25 consecutive patients with endoscopically formed gastrointestinal anastomoses. We separately analyzed 20 patients with GOO and five patients with biliary obstruction and surgically altered anatomy in whom enteroscopy-assisted ERCP had failed. Primarily, we evaluated technical feasibility, clinical efficiency and complications.

Results: In a group of 20 patients with GOO, technical feasibility was 95% (19/20) and clinical efficacy was 94.7% (18/19). There were no early complications. Late complications occurred in three patients (15.8%). Endoscopic reintervention was required in 5.3% of patients (1/19). Sixteen patients had malignant GOO. Ten patients died. The mean time from procedure to death was 92.5 days (32–259). In the group of five patients with surgically altered anatomy, technical feasibility to perform gastrointestinal anastomosis was 100%; it was followed by successful ERCP in 4/5 patients (80%) with no complications.

Conclusion: EUS-GEA can be performed endoscopically with high technical feasibility and clinical efficacy and low need for reintervention. In appropriately selected patients they are a promising alternative to surgical and radiological approaches.

Conflict of Interest: The authors declare that the article/ manuscript complies with ethical standards, patient anonymity has been respected. V. Nosek is a consultant of Boston Scientific company.

Publication Ethics: This article/manuscript has not been published or is currently being submitted for another review. The authors agree to publish their name and e-mail in the published article/manuscript.

Dedication: The article/ manuscript is not supported by a grant nor has it been created with the support of any company.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for bio medical papers.

Keywords:

endosonography – gastrointestinal anastomosis

Zdroje

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Poděkování

Zvláštní poděkování autoři práce adresují prof. Rastislavu Kundovi, M.D., F. a. s.G.E., který nezištně poskytl množství cenných rad při zavádění konceptu EUS navigovaných gastrointestinálních anastomóz na našem pracovišti a osobně přijel provést EUS-GEA v rámci tradičního EUS workshopu v Jablonci nad Nisou v listopadu 2018.