Society: ASGE

Background:
Endoscopic ultrasound-guided gastroejejunostomy (EUS-GJ) has gained popularity in treating malignant gastric outlet obstruction (GOO). EUS-GJ has also been used to manage benign GOO with promising technical and clinical success. The long-term efficacy and course of EUS-GJ in benign GOO are important to understand given the longer treatment course entailed, compared to malignant GOO in which end of life may be eminent. The aim of this study was to determine efficacy and clinical course of EUS-GJ in benign GOO.
Methods:
This was a single center retrospective series. Consecutive patients who underwent EUS-GJ from January 2017 to May 2022 for treatment of benign GOO were included. The primary outcomes were technical and clinical success. The secondary outcomes included prior endoscopic treatment, adverse events, and follow-up (clinical and endoscopic).
Results:
A total of 16 patients (43.75% female; mean age 63.3 +/- 14.8 years) underwent EUS-GJ for benign GOO. The etiology of the patients’ respective GOO’s was intrinsic in 50% of patients (8/16) and extrinsic in 50% of patients (8/16). These included pancreatitis (n=5), NSAID induced stricture (n=4), peptic ulcer disease (n=2), and SMA syndrome (n=2) among others. Technical success was achieved in 100% (16/16) patients and clinical success was achieved in 93% (15/16) patients- one patient required stent exchange due to occlusion in the first month. Hot Axios^TM stent was used; 20 mm x 10 mm in 12 patients and 15 x 10 mm in 4 patients. Stents remained in place for an average of 329 days and 25% of patients (4/16) had their stents removed on follow-up. In total, 13 patients had follow-up endoscopy, 1 patient was lost to follow-up, and 2 patients died of other chronic illnesses. On endoscopic follow-up, the stent was patent in all patients with no evidence of tissue overgrowth. On follow-up, 10 patients had normal jejunal mucosa at an average of 5.9 months from EUS-GJ, 1 patient had jejunal erosions 6-months after the procedure, and 2 patients had ulcerations at an average of 6.5 months from the procedure.
Discussion:
This series adds to very limited literature on EUS-GJ for benign GOO, showing that it is both technically feasible and clinically beneficial. This study uniquely features follow-up at up to 1444 days from EUS-GJ. In the 4 of 16 patients whose stents were removed during the study, 75% of patients (3/4) had an extrinsic etiology, which was consistent with expectations given that extrinsic causes of GOO are more likely to resolve. No patients had stent damage or tissue overgrowth and most patients had normal jejunal mucosa on follow-up. Limitations of this study include the single center retrospective nature and the small sample size. A larger and prospective data set is needed to further describe the clinical course of EUS-GJ for benign GOO.

Youssef Soliman

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