PMID- 36262515
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221021
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 10
IP  - 10
DP  - 2022 Oct
TI  - Technical feasibility and clinical success of direct "free hand" EUS-guided 
      gastroenterostomy in patients with gastric outlet obstruction.
PG  - E1358-E1363
LID - 10.1055/a-1907-5393 [doi]
AB  - Background and study aims  Endoscopic ultrasound-guided gastroenterostomy 
      (EUS-GE) with lumen-apposing metal stents (LAMS) appears to be a promising 
      intervention in management of gastroduodenal out obstruction (GOO), particularly 
      for patients for whom surgery is high risk or in a palliative setting. This study 
      aimed to evaluate the technical feasibility, procedure-associated adverse events 
      (AEs), and clinical outcome of direct "free hand" EUS-GE. Patients and methods  
      This retrospective two-center study included patients who underwent direct "free 
      hand" EUS-GE (April 2017 to March 2021) investigating technical success 
      (correctly placed LAMS), clinical outcome (successful oral nutrition), and 
      management of procedure-associated AEs. "Free hand" was defined as the use of the 
      electrocautery enhanced stent delivery system alone without additional 
      guidewire-assistance for EUS-GE creation. Results  Forty-five patients (58 % 
      women/42 % men; mean age 65 years) with malignant (n = 39), benign (n = 4) or 
      unclear (n = 2) GOO underwent direct "free hand" EUS-GE. The technical success 
      rate was 98 % (44/45). Of the patients, 95% (42/44) had less vomiting and 
      increased ability to tolerate oral food intake after the intervention. In one 
      patient, a second EUS-GE was necessary to achieve sufficient clinical 
      improvement. Procedure-associated AEs were observed in 24 % (11/45) of cases 
      including stent misplacement (n = 7), leakage (n = 1), development of a 
      gastrojejunocolic fistula (n = 1), and bleeding (n = 2), which could be all 
      managed endoscopically. Conclusions  Direct EUS-GE has a favorable risk-benefit 
      profile for patients with GOO, showing high technical success rates, manageable 
      AEs, and rapid symptom relief.
CI  - The Author(s). This is an open access article published by Thieme under the terms 
      of the Creative Commons Attribution-NonDerivative-NonCommercial License, 
      permitting copying and reproduction so long as the original work is given 
      appropriate credit. Contents may not be used for commercial purposes, or adapted, 
      remixed, transformed or built upon. 
      (https://creativecommons.org/licenses/by-nc-nd/4.0/).
FAU - Fischer, Hanna
AU  - Fischer H
AD  - Klinik fur Gastroenterologie und Hepatologie, Munchen Klinik Neuperlach, Munich, 
      Germany.
FAU - Ruther, Katharina
AU  - Ruther K
AD  - II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universitat, 
      Munich, Germany.
FAU - Abdelhafez, Mohamed
AU  - Abdelhafez M
AD  - II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universitat, 
      Munich, Germany.
FAU - Gotzberger, Manuela
AU  - Gotzberger M
AD  - Klinik fur Gastroenterologie und Hepatologie, Munchen Klinik Neuperlach, Munich, 
      Germany.
FAU - Dollhopf, Markus
AU  - Dollhopf M
AD  - Klinik fur Gastroenterologie und Hepatologie, Munchen Klinik Neuperlach, Munich, 
      Germany.
FAU - Schlag, Christoph
AU  - Schlag C
AD  - UniversitatsSpital Zurich, Klinik fur Gastroenterologie und Hepatologie, 
      Raemistrasse 100, Zurich 8091, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20221017
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC9576332
COIS- Competing interests The authors declare that they have no conflict of interest.
EDAT- 2022/10/21 06:00
MHDA- 2022/10/21 06:01
PMCR- 2022/10/01
CRDT- 2022/10/20 02:36
PHST- 2022/03/26 00:00 [received]
PHST- 2022/07/08 00:00 [accepted]
PHST- 2022/10/20 02:36 [entrez]
PHST- 2022/10/21 06:00 [pubmed]
PHST- 2022/10/21 06:01 [medline]
PHST- 2022/10/01 00:00 [pmc-release]
AID - 10.1055/a-1907-5393 [doi]
PST - epublish
SO  - Endosc Int Open. 2022 Oct 17;10(10):E1358-E1363. doi: 10.1055/a-1907-5393. 
      eCollection 2022 Oct.