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Same-session double EUS-guided bypass versus surgical gastroenterostomy and hepaticojejunostomy: an international multicenter comparison - 14/07/23

Doi : 10.1016/j.gie.2023.03.019 
Michiel Bronswijk, MD 1, 2, ⁎, Giuseppe Vanella, MD 3, Roy L.J. van Wanrooij, MD, PhD 4, 5, Jayanta Samanta, MD 6, Jonas Lauwereys, BSc 1, 2, Enrique Pérez-Cuadrado-Robles, MD, PhD 7, Giuseppe Dell’Anna, MD 3, Jahnvi Dhar, MD 6, Vikas Gupta, MS, MCh 6, Hannah van Malenstein, MD, PhD 1, Wim Laleman, MD, PhD 1, Joris Jaekers, MD 8, Halit Topal, MD 8, Baki Topal, MD, PhD 8, Stefano Crippa, MD, PhD 9, Massimo Falconi, MD 9, Marc G. Besselink, MD, PhD 10, 11, Nouredin Messaoudi, MD, PhD 12, Paolo Giorgio Arcidiacono, MD, PhD 3, Rastislav Kunda, MD, PhD 12, Schalk Van der Merwe, MD, PhD 1
1 Department of Gastroenterology and Hepatology 
8 Department of Visceral Surgery, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium 
2 Department of Gastroenterology and Hepatology, Imelda Hospital Bonheiden, Bonheiden, Belgium 
3 Pancreatobiliary Endoscopy and Endosonography Division 
9 Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute and University, Milan, Italy 
4 Department of Gastroenterology and Hepatology 
10 Department of Surgery, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands 
5 Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands 
6 Departments of Gastroenterology and GI Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India 
7 Department of Gastroenterology, Georges-Pompidou European Hospital, APHP, Centre, University of Paris Cité, Paris, France 
11 Cancer Center Amsterdam, Amsterdam, The Netherlands 
12 Department of Surgery, Department of Gastroenterology and Hepatology, Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium 

∗Reprint requests: Michiel Bronswijk, MD, Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, Herestraat 49, Leuven 3000, Belgium.Department of Gastroenterology and HepatologyUniversity Hospitals GasthuisbergHerestraat 49Leuven3000Belgium

Abstract

Background and Aims

Gastric outlet and biliary obstruction are common manifestations of GI malignancies and some benign diseases for which standard treatment would be surgical gastroenterostomy and hepaticojejunostomy (ie, “double bypass”). Therapeutic EUS has allowed for the creation of an EUS-guided double bypass. However, same-session double EUS-guided bypass has only been described in small proof-of-concept series and lacks a comparison with surgical double bypass.

Methods

A retrospective multicenter analysis was performed of all consecutive same-session double EUS-guided bypass procedures performed in 5 academic centers. Surgical comparators were extracted from these centers’ databases from the same time interval. Efficacy, safety, hospital stay, nutrition and chemotherapy resumption, long-term patency, and survival were compared.

Results

Of 154 identified patients, 53 (34.4%) received treatment with EUS and 101 (65.6%) with surgery. At baseline, patients undergoing EUS exhibited higher American Society of Anesthesiologists scores and a higher median Charlson Comorbidity Index (9.0 [interquartile range {IQR}, 7.0-10.0] vs 7.0 [IQR, 5.0-9.0], P < .001). Technical success (96.2% vs 100%, P = .117) and clinical success rates (90.6% vs 82.2%, P = .234) were similar when comparing EUS and surgery. Overall (11.3% vs 34.7%, P = .002) and severe adverse events (3.8% vs 19.8%, P = .007) occurred more frequently in the surgical group. In the EUS group, median time to oral intake (0 days [IQR, 0-1] vs 6 days [IQR, 3-7], P < .001) and hospital stay (4.0 days [IQR, 3-9] vs 13 days [IQR, 9-22], P < .001) were significantly shorter.

Conclusions

Despite being used in a patient population with more comorbidities, same-session double EUS-guided bypass achieved similar technical and clinical success and was associated with fewer overall and severe adverse events when compared with surgical gastroenterostomy and hepaticojejunostomy.

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Abbreviations : AE, ASA, EUS-AS, EUS-BD, EUS-CD, EUS-GE, EUS-HG, GOO, IQR, SEMS, SGJ


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 DISCLOSURE: The following authors disclosed financial relationships: M. Bronswijk: Research support from Boston Scientific and Ovesco/Fides Medical; consultant for Dekra and Taewoong–Prion Medical. R. L. J. van Wanrooij, E. Pérez-Cuadrado-Robles, H. van Malenstein: Consultant for Boston Scientific. W. Laleman: Consultant for Boston Scientific and Cook Medical; Chair in therapeutic EUS for Boston Scientific. R. Kunda: Consultant for Boston Scientific, Omega Medical Imaging, Ambu, MI Tech, Apollo Endosurgery, EndiaTx, Medconsgroup, Q3 Medical-AMG International, and Tigen Pharma. S. Van der Merwe: Consultant for Cook, Pentax, and Olympus; Chair in interventional endoscopy for Cook Medical and Chair in therapeutic EUS for Boston Scientific. All other authors disclosed no financial relationships.
 DIVERSITY, EQUITY, AND INCLUSION: While citing references scientifically relevant for this work, we actively worked to promote gender balance in our reference list. The author list of this paper includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.


© 2023  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 98 - N° 2

P. 225 - agosto 2023 Ritorno al numero
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