TY - JOUR
T1 - Same-session double EUS-guided bypass versus surgical gastroenterostomy and hepaticojejunostomy
T2 - an international multicenter comparison
AU - Bronswijk, Michiel
AU - Vanella, Giuseppe
AU - van Wanrooij, Roy L. J.
AU - Samanta, Jayanta
AU - Lauwereys, Jonas
AU - Pérez-Cuadrado-Robles, Enrique
AU - Dell'Anna, Giuseppe
AU - Dhar, Jahnvi
AU - Gupta, Vikas
AU - van Malenstein, Hannah
AU - Laleman, Wim
AU - Jaekers, Joris
AU - Topal, Halit
AU - Topal, Baki
AU - Crippa, Stefano
AU - Falconi, Massimo
AU - Besselink, Marc G.
AU - Messaoudi, Nouredin
AU - Arcidiacono, Paolo Giorgio
AU - Kunda, Rastislav
AU - van der Merwe, Schalk
N1 - Funding Information:
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.
Funding Information:
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.
Publisher Copyright:
© 2023 American Society for Gastrointestinal Endoscopy
PY - 2023/8
Y1 - 2023/8
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/85163873088
U2 - 10.1016/j.gie.2023.03.019
DO - 10.1016/j.gie.2023.03.019
M3 - Article
C2 - 36990124
SN - 0016-5107
VL - 98
SP - 225-236.e1
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 2
ER -