EUS-guided gastroenterostomy with a lumen apposing self-expandable metallic stent relieves gastric outlet obstruction – a Scandinavian case series

Figures & data

Figure 1. EUS image from the stomach during deployment of LAMS. The delivery device has been placed in the water-expanded small bowel and the distal flange has been released.

Figure 2. View from the stomach through the LAMS into the small bowel with a double-pigtail stent introduced to prevent obstruction and migration.

Figure 3. CT image of EUS-guided gastroenterostomy made with a lumen apposing metal stent placed between the greater curvature of the stomach and a small bowel loop bypassing a tumor-stenosis in the hilar region of the liver.

Table 1. Demographic and procedural data.

Sex, n (%)
Female	13 (39)
Male	20 (61)
Age, mean (SD), years	73 (13.3)
ASA score
2	6 (18)
3	23 (70)
4	4 (12)
Malignant etiology, n (%)	28 (85)
Pancreatic cancer	8 (24)
Colorectal cancer	6 (18)
Duodenal cancer	5 (15)
Pulmonary cancer metastasis	2 (6)
Cholangiocarcinoma	2 (6)
Lymphoma	1 (3)
Urinary tract cancer metastasis	1 (3)
Other	3 (9)
Benign etiology, n (%)	5 (15)
Chronic pancreatitis	3 (9)
Aorto-duodenal syndrome	2 (6)
Place of treatment, n (%)
Centre A	19 (58)
Centre B	14 (42)
Type of anesthesia, n (%)
General	25 (76)
Conscious sedation	8 (24)
Procedure time, median (range), min	71 (34-195)
Stent type, n (%)
LAMS, 10 × 15 mm	22 (79)
LAMS, 10 × 20 mm	7 (21)

Table 2. Results for 33 patients with EUS-guided gastroenterostomy.

Technical success, n (%)	33 (100)
In first attempt	31 (94)
In second attempt	2 (100)
Ability to eat after procedure	30 (91)
Hospital stay, median (range), days	3 (1-12)
Overall survival time, median (range), weeks	13 (0.5-135)
Malignant indications (n = 28)	8.5 (0.5-76)
Benign indication (n = 5)	26 (20-135)
Dead at time of study, n (%)	27^a (82)
Alive at time of study, n (%)	6^b (18)

^a25 malignant.

^b3 malignant.

Table 3. Patients with non-malignant indications for EUS guided gastroenterostomy.

Pt. no.	Age	Diagnose (reason for GOO)	Gen. anesthesia	ASA score	Adverse events	Survival (weeks)	Status
16	80	Aortoduodenal syndr. (AAA inoperable), and multiple admissions for aspiration pneumonia	Yes	3	None (elective change of LAMS after 2.5 years)	135	Deceased
20	67	Chron. Pancreatitis, pseudocyst, stenosis of the proximal duodenum	No	2	Late stent migration (Moderate)	30	Alive
28	60	Chron. Pancreatitis, compression of the proximal duodenum	Yes	2	None	26	Deceased
31	62	Aortoduodenal syndr. (AAA TAVAR treated)	Yes	3	None	21	Alive
32	73	Chron. Pancreatitis (previous surgical GEA w secondary stenosis)	Yes	3	None	20	Alive

Table 4. Adverse events.

Adverse events, n (%)	10 (30)
Stent displacement/migration	3 (9)
Bleeding	2 (6) (1 fatal)
Pneumonia/aspiration	3 (9) (2 fatal)
Re-feeding syndrome	1 (3) (1 fatal)
Two or more attempts/punctures	1 (3)
Adverse events timing, n (% of AE)
Procedural	2 (20)
Post procedural	6 (60)
Late	2 (20)
Adverse events attributable to procedure, n (% of AE)
Definite	7 (70)
Probable	3 (30)
Adverse events, severity, n (% of AE)
Mild	1 (10)
Moderate	5 (50)
Fatal	4 (40)