Background and aims: Surgery is currently the first-choice treatment for malignant bowel obstruction (MBO), however many patients are deemed inoperable. Endoscopic ultrasound (EUS) guided colo-entero-anastomosis with lumen apposing metal stents (LAMS) could represent a new effective palliative treatment option. We aimed to assess the technical success and safety of EUS-guided colo-entero-anastomosis, symptoms relief, time of re-feeding, hospital stay and overall survival.
Methods: All consecutive patients undergoing EUS guided colo-entero-anastomosis for MBO from November 2021 to September 2023 were retrospectively enrolled at four tertiary referral European centres. All cases were discussed in a multidisciplinary meeting, patients declared unfit for surgery and colonic stent placement or spontaneously refused surgery. Demographic, clinical and procedural data including the clinical outcome and adverse events were recorded. Data were expressed as median [range]. Comparisons were made by using the χ2 test, Student t-test, or Mann–Whitney u-test.
Results: Twelve patients were enrolled (58.3% female, median age 72.5 [42-85]). In 75%of cases the primary tumor was colonic adenocarcinoma and 91.7% of patients had a Stage IV disease. In 83.3% of the procedures the LAMS used was the Hot AXIOS^TM, in 16.7% the Hot SPAXUS^TM. Technical success was achieved in all procedures (100%). No LAMS misdeployment or other immediate post procedure adverse events were observed. Delayed post-procedural complications were recorded in 3 (25%) patients,however direct correlation with the procedure could not be ascertained. Clinical success was achieved in 10 (83.3%) patients. The median time of oral diet resumption was 1 [1-2] day. The median post-procedure hospital stay was 9 [1-20] days and overall median survival was 47.5 [2-270] days.
Conclusions: EUS guided colo-entero-anastomosis is a feasible and safe technique, and can be considered as a valid alternative to standard approaches for MBO treatment in highly selected patients.

LAMS successfully deployed under fluoroscopic guide between the target distal ileum and the right colon. Technical success is then confirmed by passage of contrast through the LAMS into the distal ileum with no extraluminal spilling.

Giuseppe Tonini

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