PMID- 34736930
OWN - NLM
STAT- MEDLINE
DCOM- 20220414
LR  - 20220414
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 95
IP  - 4
DP  - 2022 Apr
TI  - Optimizing outcomes for EUS-guided gastroenterostomy: results of a Standardized 
      Clinical Assessment and Management Plan (with video).
PG  - 682-691.e3
LID - S0016-5107(21)01767-3 [pii]
LID - 10.1016/j.gie.2021.10.030 [doi]
AB  - BACKGROUND AND AIMS: EUS-guided gastroenterostomy (EUS-GE) has emerged as an 
      option for managing malignant gastric outlet obstruction (GOO). However, there is 
      currently no standardized technique, and outcomes are variable with 
      inconsistencies both within and across centers. The present study aims to develop 
      and assess outcomes of a Standardized Clinical and Assessment Management Plan 
      (SCAMP) for EUS-GE. METHODS: A SCAMP was created by a multidisciplinary team to 
      develop and optimize a systematic approach for EUS-GE. This is a single-center, 
      prospective cohort study on patients undergoing EUS-GE for GOO, using the 
      developed SCAMP. Baseline demographics, cancer diagnosis and stage, Eastern 
      Cooperative Oncology Group (ECOG) performance score, clinical and technical 
      success, adverse events (AEs), and obstruction recurrence were collected. Primary 
      outcomes included technical and clinical success. Obstruction-free and overall 
      survival were calculated and compared with Kaplan-Meier analysis. RESULTS: Fifty 
      patients underwent EUS-GE in accordance with the SCAMP. Mean age was 67 years, 
      54% were women, and pancreatic cancer represented the largest cancer type (51%). 
      Technical success was 100% and clinical success 92%. AEs occurred in 2 patients 
      (4%). Recurrent obstruction occurred in 16%, related to distal small-bowel 
      obstruction from carcinomatosis. Estimated mean obstruction-free survival was 217 
      days. Median overall survival was 230 days among patients with ECOG scores 0 to 2 
      and 82 days for ECOG scores >/=3 (P = .008). CONCLUSIONS: The standardized 
      technique used was associated with high technical and clinical success and low 
      rates of AEs, morbidity and procedure-related mortality. Adopting a similar 
      uniform systematic approach may improve procedural outcomes and dissemination.
CI  - Copyright (c) 2022. Published by Elsevier Inc.
FAU - Abbas, Ali
AU  - Abbas A
AD  - Division of Gastroenterology, Brigham and Women's Hospital, Boston, 
      Massachusetts, USA; Division of Digestive Diseases & Nutrition, University of 
      South Florida, Tampa, Florida, USA.
FAU - Dolan, Russell D
AU  - Dolan RD
AD  - Division of Gastroenterology, Brigham and Women's Hospital, Boston, 
      Massachusetts, USA.
FAU - Thompson, Christopher C
AU  - Thompson CC
AD  - Division of Gastroenterology, Brigham and Women's Hospital, Boston, 
      Massachusetts, USA.
LA  - eng
PT  - Journal Article
PT  - Video-Audio Media
DEP - 20211101
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Aged
MH  - *Endosonography/methods
MH  - Female
MH  - *Gastric Outlet Obstruction/etiology/surgery
MH  - Gastroenterostomy/methods
MH  - Humans
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Stents
EDAT- 2021/11/06 06:00
MHDA- 2022/04/15 06:00
CRDT- 2021/11/05 05:47
PHST- 2021/06/12 00:00 [received]
PHST- 2021/10/24 00:00 [accepted]
PHST- 2021/11/06 06:00 [pubmed]
PHST- 2022/04/15 06:00 [medline]
PHST- 2021/11/05 05:47 [entrez]
AID - S0016-5107(21)01767-3 [pii]
AID - 10.1016/j.gie.2021.10.030 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2022 Apr;95(4):682-691.e3. doi: 10.1016/j.gie.2021.10.030. 
      Epub 2021 Nov 1.