Optimizing outcomes for EUS-guided gastroenterostomy: results of a Standardized Clinical Assessment and Management Plan (with video) - 15/03/22
Abstract |
Background and Aims |
EUS-guided gastroenterostomy (EUS-GE) has emerged as an option for managing malignant gastric outlet obstruction (GOO). However, there is currently no standardized technique, and outcomes are variable with inconsistencies both within and across centers. The present study aims to develop and assess outcomes of a Standardized Clinical and Assessment Management Plan (SCAMP) for EUS-GE.
Methods |
A SCAMP was created by a multidisciplinary team to develop and optimize a systematic approach for EUS-GE. This is a single-center, prospective cohort study on patients undergoing EUS-GE for GOO, using the developed SCAMP. Baseline demographics, cancer diagnosis and stage, Eastern Cooperative Oncology Group (ECOG) performance score, clinical and technical success, adverse events (AEs), and obstruction recurrence were collected. Primary outcomes included technical and clinical success. Obstruction-free and overall survival were calculated and compared with Kaplan-Meier analysis.
Results |
Fifty patients underwent EUS-GE in accordance with the SCAMP. Mean age was 67 years, 54% were women, and pancreatic cancer represented the largest cancer type (51%). Technical success was 100% and clinical success 92%. AEs occurred in 2 patients (4%). Recurrent obstruction occurred in 16%, related to distal small-bowel obstruction from carcinomatosis. Estimated mean obstruction-free survival was 217 days. Median overall survival was 230 days among patients with ECOG scores 0 to 2 and 82 days for ECOG scores ≥3 (P = .008).
Conclusions |
The standardized technique used was associated with high technical and clinical success and low rates of AEs, morbidity and procedure-related mortality. Adopting a similar uniform systematic approach may improve procedural outcomes and dissemination.
Le texte complet de cet article est disponible en PDF.Abbreviations : AE, ECOG, EUS-GE, GOO, LAMS, SCAMP
Plan
| DISCLOSURE: The following author disclosed financial relationships: C. C. Thompson: Consultant for Apollo Endosurgery, Boston Scientific, Covidien/Medtronic, EnVision Endoscopy, Fractyl, GI Dynamics, Olympus/Spiration, and USGI Medical; research support from Apollo Endosurgery, Aspire Bariatrics, Boston Scientific, GI Dynamics, Olympus/Spiration, USGI Medical, and Fujifilm; general partner with BlueFlame Healthcare Venture Fund; advisory board for Fractyl and USGI Medical; ownership interest in GI Windows; founder, consultant for, and board member of Enterasense; institutional research grant from ERBE; consultant for, institutional grant from Lumendi. All other authors disclosed no financial relationships. |
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| If you would like to chat with an author of this article, you may contact Dr Thompson at mryan15@partners.org. |
Vol 95 - N° 4
P. 682 - avril 2022 Retour au numéro
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