Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction
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Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality oflife. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent(LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GEtechnique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslimendoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS haveshown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studiescomparing EUS-GE and surgical astrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, witha lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.
Abstract
Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality oflife. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent(LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GEtechnique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslimendoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS haveshown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studiescomparing EUS-GE and surgical astrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, witha lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.
참고문헌 (27)
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