title: Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017.
abstract: Gastric outlet obstruction (GOO) can be caused by benign and malignant diseases and often leads to a reduction in patient quality of life. Lately, endoscopic ultrasonography (EUS)-guided gastroenterostomy (EUS-GE) has emerged. At the present time, there are three types of EUS-GE using lumen-apposing biflanged metal stents (LAMS): (i) direct EUS-GE; (ii) assisted EUS-GE using retrieval/dilating balloon, single balloon overtube, nasobiliary drain and ultraslim endoscope; and (iii) EUS-guided double-balloon-occluded gastrojejunostomy bypass (EPASS). Overall technical success rate is approximately 90% regardless of technique used, although this is based on two retrospective studies only. In the EPASS procedure, the success rate of the one-step procedure was higher than that of the two-step procedure (100% vs 82%). Clinical success was almost uniform when stent placement was technically successful. Although there have been no-stent induced procedural deaths, adverse events were seen in several cases. One technically failed case carried out using balloon-assisted EUS-GE was converted to laparoscopic gastrojejunostomy. Two failed cases in EPASS procedure improved with conservative treatment. In the present review, we show the feasibility and outcomes using novel EUS-GE using LAMS. Clinical prospective trials with comparison to luminal enteral stents and surgical GE are warranted.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.affiliation: Digestive Disease Institute at Virginia Mason Medical Center, Seattle, USA.
authors.forename: Shayan
authors.initials: S
authors.lastname: Irani
authors.affiliation: Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Anthony Yuen
authors.initials: AY
authors.lastname: Bun Teoh
mesh_terms: D019160:Endosonography / Q000379:methods*; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: anastomosis; endoscopic ultrasonography; endoscopic ultrasonography-guided gastroenterostomy; gastrojejunostomy; lumen-apposing metal stent