Su1265 CLINICAL UTILITY OF ENDOSCOPIC ULTRASOUND-GUIDED DEPLOYMENT OF LUMEN-APPOSING METAL STENTS FOR MALIGNANT AFFERENT LIMB SYNDROME; A DESCRIPTIVE ANALYSIS

Abstract

Endoscopic ultrasound-guided deployment of a lumen apposing metal stent (LAMS) has recently emerged as a favorable interventional modality for the treatment of malignant afferent limb syndrome (ALS). However, data regarding the safety and feasibility of this approach is limited. A systematic literature search was performed of Medline(Ovid) and Embase from inception-July 2019. All studies were screened by two authors to identify studies reporting EUS-guided deployment of LAMS for the treatment of malignant ALS. Due to the expected paucity of data, case reports were included in our analysis. Pooled data was reported as proportions with 95% confidence interval (CI). Overall, we identified 15 reports enrolling 32 patients with a mean age of 62, of whom 16 (50%) were female. A history of pancreatoduodenectomy was reported in 23 (72%) patients (Table 1). The mean time from surgical tumor resection to ALS presentation was 14 months (SD 6.5). The most common cause of ALS was peritoneal carcinomatosis (11; 34%). Prior endoscopic intervention for ALS was performed in 4 (13%) patients. Electrocautery enhanced LAMS insertion was performed in 17 (53%) cases, and a needle knife was utilized in 2 (6%) cases. All patients successfully underwent EUS-guided deployment of a LAMS to create a gastroenterostomy with subsequent symptomatic and biochemical improvement of ALS. The most common anastomosis created was a gastrojejunostomy (22, 69%), followed by a jejunojejunostomy (7, 22%). No adverse events were reported over the study duration. Re-obstruction and reintervention were reported in 3 (9%) and 4 (13%) cases, respectively. Over a mean follow-up period of 98.27 days (95%CI 74.58-121.96), one mortality due to ALS was reported. EUS-guided gastroenterostomy (EUS-GE) by deployment of a LAMS for the treatment of ALS is a technically feasible and clinically favorable intervention, particularly in patients who are poor surgical candidates. A lack of long-term follow up was identified upon systematically analyzing the literature. Future well-designed studies with long-term follow-up are needed to further explore the clinical utility of EUS-GE for the treatment of ALS.