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Abstract
Background and Aims
Interventions for malignant small bowel obstruction (MSBO) may be limited by extent
of peritoneal disease, rendering surgical or traditional endoscopic methods (i.e.
luminal stenting or decompressive gastrostomy) unfeasible. We demonstrate the novel
use of endoscopic ultrasound (EUS)-guided lumen-apposing metal stent (LAMS) for enterocolonic
bypass in patients with MSBO who are deemed high risk for surgery.
Methods
Across 3 tertiary US centers, a retrospective series of consecutive patients underwent
attempt at EUS-guided enterocolostomy (EUS-EC) for palliation of acute SBO due to
malignant causes. Technique and devices utilized were described, and patient demographics
and outcome data were collected.
Results
A total of 10 patients were included, of whom 9 (90.0%) were men, with median age
64.5 +/- 14.0 years, and 1.5 +/- 2.1 years post-diagnosis. Technical success was achieved
in 8 of 10 patients (80.0%) and clinical success in 7 of 10 (70.0%), with a single
major adverse event (10.0%) of aspiration. Median time until resumption of oral intake
was 1.0 day post-procedure (range 0-8 days), with interval to discharge home of 6.5
days, and survival 57.0 days.
Conclusions
EUS-EC is a new alternative for palliation of acute SBO due to advanced malignant
disease when conservative measures fail and other surgical or endoscopic options are
not possible. Additional larger studies with longer duration of follow-up are needed
to further define efficacy and safety of this approach.
Keywords
Acronyms:
EUS (Endoscopic ultrasound), EUS-EC (Endoscopic ultrasound-guided enterocolostomy), LAMS (Lumen-apposing metal stent), SBO (Small bowel obstruction), MSBO (Malignant small bowel obstruction), PEG (Percutaneous endoscopic gastrostomy), EUS-GE (Endoscopic ultrasound-guided gastroenterostomy), CT (Computed tomography), LOS (Length-of-stay), ES (Enteral stents)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
December 14,
2022
Received in revised form:
December 13,
2022
Received:
August 17,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Authorship Roles:
Emily R. Jonica: Study design and data collection; composed manuscript & video.
SriHari Mahadev: Endoscopist for procedures, reviewed manuscript.
Andrew J Gilman: Assisted with data collection and coordination.
Reem Z. Sharaiha: Endoscopist for procedures, reviewed manuscript.
Todd Baron: Endoscopist for procedures, reviewed manuscript.
Shayan Irani: Endoscopist for procedures, assisted with study design as senior author, reviewed manuscript and video.
Funding: N/A (unfunded)
Identification
Copyright
© 2022 by the American Society for Gastrointestinal Endoscopy
