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Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction

Clinical Endoscopy 2020년 53권 5호 p.510 ~ 518
Tonozuka Ryosuke, Tsuchiya Takayoshi, Mukai Shuntaro, Nagakawa Yuichi, Itoi Takao,
소속 상세정보
 ( Tonozuka Ryosuke ) - Tokyo Medical University Department of Gastroentelorogy and Hepatology
 ( Tsuchiya Takayoshi ) - Tokyo Medical University Department of Gastroentelorogy and Hepatology
 ( Mukai Shuntaro ) - Tokyo Medical University Department of Gastroentelorogy and Hepatology
 ( Nagakawa Yuichi ) - Tokyo Medical University Department of Gastrointestinal and Pediatric Surgery
 ( Itoi Takao ) - Tokyo Medical University Department of Gastroenterology and Hepatology

Abstract


Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality of life. 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-GE technique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslim endoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS have shown technical and clinical success rates (regardless of technique and etiology) of 87%?100% and 84%?100%, respectively. Studies comparing EUS-GE and surgical gastrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, with a 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.

키워드

Duodenal obstruction; Endosonography; Gastric bypass; Gastric outlet obstruction; Gastroenterostomy

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