Endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stents: a retrospective multicentric comparison of wireless and over-the-wire techniques

摘要

Background Endoscopic ultrasound-guided gastroenter-ostomy (EUS-GE) using lumen-apposing metal stents (LAMSs) appears to be effective and safe in gastric outlet obstruction (GOO); however, the EUS-GE procedure is not standardized, with the use of assisted or direct methods still debated. The aim of this study was to compare the outcomes of EUS-GE techniques focusing on an assisted with orointestinal drain wireless endoscopic simplified technique (WEST) and the nonassisted direct technique over a guidewire (DTOG). Method This was a multicenter European retrospective study involving four tertiary centers. Consecutive patients who underwent EUS-GE for GOO between August 2017 and May 2022 were included. The primary aim was to compare the technical success and adverse event (AE) rates of the different EUS-GE techniques. Clinical success was also analyzed. Results 71 patients (mean SD age 66.2 10 years; 42.3 men; 80.3 malignant etiology) were included. Technical success was higher in the WEST group (95.1 vs. 73.3; estimate of relative risk from odds ratio (eRR) 3.2, 95CI 0.94-10.9; P=0.01). The rate of AEs was lower in the WEST group (14.6 vs. 46.7; eRR 2.3, 95CI 1.2-4.5; P= 0.007). Clinical success was comparable between the two groups at 1 month (97.5 vs. 89.3). The median follow-up was 5 months (range 1 -57). Conclusion The WEST resulted in a higher technical success rate with fewer AEs, with clinical success comparable with the DTOG. Therefore, the WEST (with an orointestinal drain) should be preferred when performing EUS-GE.