PMID- 28750837 OWN - NLM STAT- MEDLINE DCOM- 20181106 LR - 20181106 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 87 IP - 5 DP - 2018 May TI - EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques. PG - 1215-1221 LID - S0016-5107(17)32123-5 [pii] LID - 10.1016/j.gie.2017.07.030 [doi] AB - BACKGROUND: EUS-guided gastroenterostomy (EUS-GE) is a developing modality in the management of gastric outlet obstruction (GOO) with several technical approaches, including the direct and balloon-assisted techniques. The aim of this study was to compare the direct with the balloon-assisted modality while further defining the role of EUS-GE in GOO. METHODS: This multicenter, retrospective study involved consecutive patients who underwent EUS-GE with the direct or balloon-assisted technique for GOO (January 2014 to October 2016). The primary outcome was technical success. Secondary outcomes were success (ability to tolerate at least a full fluid diet), procedure time, and rate/severity of adverse events (AEs). RESULTS: A total of 74 patients (44.6% women; mean age 63.0 +/- 11.7 years) underwent EUS-GE for GOO (direct gastroenterostomy, n = 52; balloon-assisted gastroenterostomy, n = 22). GOO was of malignant and benign etiology in 66.2% and 33.8% of patients, respectively. Technical success was achieved in 94.2% of the direct and 90.9% of the balloon-assisted approach (P = .63). Mean procedure time was shorter with the direct technique (35.7 +/- 32.1 minutes vs 89.9 +/- 33.3 minutes, P < .001). The clinical success rate was 92.3% for the direct technique and 90.9% for the balloon-assisted modality (P = 1.00), with a mean time to oral intake of 1.32 +/- 2.76 days. The AE rate was 6.8% with only 1 severe AE noted. Rate of AEs, postprocedure length of stay, need for reintervention, and survival were similar between the 2 groups. CONCLUSIONS: EUS-GE is effective and safe in the management of GOO. The direct technique may be the preferred method given its shorter procedure time when compared with the balloon-assisted approach. Prospective trials are needed to confirm these findings. CI - Copyright (c) 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. FAU - Chen, Yen-I AU - Chen YI AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montreal, Quebec, Canada. FAU - Kunda, Rastislav AU - Kunda R AD - Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark. FAU - Storm, Andrew C AU - Storm AC AD - Division of Gastroenterology, Hepatology and endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA. FAU - Aridi, Hanaa Dakour AU - Aridi HD AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Thompson, Christopher C AU - Thompson CC AD - Division of Gastroenterology, Hepatology and endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA. FAU - Nieto, Jose AU - Nieto J AD - Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida, USA. FAU - James, Theodore AU - James T AD - Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA. FAU - Irani, Shayan AU - Irani S AD - Division of Gastroenterology and Hepatology, Virgina Mason Medical Center, Seattle, Washington, USA. FAU - Bukhari, Majidah AU - Bukhari M AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Gutierrez, Olaya Brewer AU - Gutierrez OB AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Agarwal, Amol AU - Agarwal A AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Fayad, Lea AU - Fayad L AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Moran, Robert AU - Moran R AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Alammar, Nuha AU - Alammar N AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Sanaei, Omid AU - Sanaei O AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Canto, Marcia I AU - Canto MI AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Singh, Vikesh K AU - Singh VK AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. FAU - Baron, Todd H AU - Baron TH AD - Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA. FAU - Khashab, Mouen A AU - Khashab MA AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study DEP - 20170724 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 SB - IM MH - Aged MH - Endosonography/*methods MH - Female MH - Gastric Outlet Obstruction/*surgery MH - Gastroenterostomy/*methods MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Surgery, Computer-Assisted/*methods MH - Treatment Outcome EDAT- 2017/07/29 06:00 MHDA- 2018/11/07 06:00 CRDT- 2017/07/29 06:00 PHST- 2017/03/08 00:00 [received] PHST- 2017/07/17 00:00 [accepted] PHST- 2017/07/29 06:00 [pubmed] PHST- 2018/11/07 06:00 [medline] PHST- 2017/07/29 06:00 [entrez] AID - S0016-5107(17)32123-5 [pii] AID - 10.1016/j.gie.2017.07.030 [doi] PST - ppublish SO - Gastrointest Endosc. 2018 May;87(5):1215-1221. doi: 10.1016/j.gie.2017.07.030. Epub 2017 Jul 24.