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
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 02, 2021
Accepted:
July 22,
2021
Received:
March 10,
2021
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: S. S. Irani: Consultant for Boston Scientific and Gore Medical. R. Z. Sharaiha: Consultant for Boston Scientific, Olympus America, Cook Medical, and Lumendi. T. E. Kowalski: Consultant for Boston Scientific and Medtronic. D. K. Pleskow: Consultant for Boston Scientific, Olympus America, FujiFilm, and Medtronic. K. D.-C. Pham: Consultant for Boston Scientific; speaker for Boston Scientific, Cook Medical, Olympus America, and Taewoong Medical; advisory board of Ambu. A. Anderloni: Consultant for Boston Scientific, Medtronic, and Olympus. H. S. Khara, B. Paranandi, B. Confer: Consultant for Boston Scientific and Merit Endotek. M. Barthet, T. Weber, J. R. Aparicio: Consultant for Boston Scientific. M. A. Khashab: Consultant for Boston Scientific, Apollo, Olympus America, Medtronic, and GI Supply. C. Fiabbri: Consultant for Boston Scientific; speaker for Steris. M. T. Huggett: Consultant for Boston Scientific, Olympus UK, and Cook Medical. All other authors disclosed no financial relationships.
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© 2022 by the American Society for Gastrointestinal Endoscopy
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Access this article on ScienceDirectLinked Article
- EUS gastroenterostomy: Why do bad things happen to good procedures?Gastrointestinal EndoscopyVol. 95Issue 1
- PreviewWith 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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