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Classification, outcomes, and management of misdeployed stents during EUS-guided gastroenterostomy

Published:August 02, 2021DOI:https://doi.org/10.1016/j.gie.2021.07.023

      Background and Aims

      Stent misdeployment (SM) has hindered the dissemination of EUS-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction (GOO) management. We aimed to provide a classification system for SM during EUS-GE and study clinical outcomes and management accordingly.

      Methods

      This is a retrospective study involving 16 tertiary care centers (8 in the United States, 8 in Europe) from March 2015 to December 2020. Patients who developed SM during EUS-GE for GOO were included. We propose classifying SM into 4 types. The primary outcome was rate and severity of SM (per American Society for Gastrointestinal Endoscopy lexicon), whereas secondary outcomes were clinical outcomes and management of dislodgement according to the SM classification type, in addition to salvage management of GOO after SM.

      Results

      From 467 EUS-GEs performed for GOO during the study period, SM occurred in 46 patients (9.85%). Most SMs (73.2%) occurred during the first 13 EUS-GE cases by the performing operators. SM was graded as mild (n = 28, 60.9%), moderate (n = 11, 23.9%), severe (n = 6, 13.0%), or fatal (n = 1, 2.2%), with 5 patients (10.9%) requiring surgical intervention. Type I SM was the most common (n = 29, 63.1%), followed by type II (n = 14, 30.4%), type IV (n = 2, 4.3%), and type III (n = 1, 2.2%). Type I SM was more frequently rated as mild compared with type II SM (75.9% vs 42.9%, P = .04) despite an equivalent rate of surgical repair (10.3% vs 7.1%, P = .7). Overall, 4 patients (8.7%) required an intensive care unit stay (median, 2.5 days). The median length of stay was 4 days after SM.

      Conclusions

      Although SM is not infrequent during EUS-GE, most are type I, mild/moderate in severity, and can be managed endoscopically with a surgical intervention rate of approximately 11%.

      Graphical abstract

      Abbreviations:

      AE (adverse event), ICU (intensive care unit), LAMS (lumen-apposing metal stent), SM (stent misdeployment), EUS-GE (EUS-guided gastroenterostomy), GOO (gastric outlet obstruction), NOTES (natural orifice transluminal endoscopic surgery)
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      Linked Article

      • EUS gastroenterostomy: Why do bad things happen to good procedures?
        Gastrointestinal EndoscopyVol. 95Issue 1
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          With the advent of lumen-apposing metal stents (LAMSs), the creation of anastomoses with the use of flexible endoscopes has become a reality. EUS-guided gastroenterostomy (EUS-GE) was first shown to be feasible in animals in 20121 and was described in humans 3 years later.2,3 EUS-GE has become increasingly used throughout the world for the management of gastric outlet obstruction (GOO). Indeed, a recent international, multicenter retrospective study showed EUS-GE to have technical and clinical success rates that rival those of laparoscopic gastroenterostomy (GE) but with a reduction in duration to resumption of oral intake, shorter median hospital days, and a lower rate of adverse events.
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