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EUS-guided enterocolostomy with lumen-apposing metal stent for palliation of malignant small-bowel obstruction (with video)

Published:December 23, 2022DOI:https://doi.org/10.1016/j.gie.2022.12.016
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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)
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