Su1270 EFFICACY AND SAFETY OF ENDOSCOPIC ULTRASONOGRAPHY-GUIDED GASTROJEJUNOSTOMY FOR TREATMENT OF GASTRIC OUTLET OBSTRUCTION USING A SAFE-PASS DOUBLE SCOPE (SPDS) TECHNIQUE

Abstract

Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is an evolving technique for the management of gastric outlet obstruction (GOO). The optimal approach is yet to be defined with reported technical failures and stent misplacement secondary to small intestinal mobility and proximity of the colon to the puncture site. We aimed to investigate the technical feasibility and safety of a retrograde EUS GJ technique using a safe-pass double scope (SPDs) approach. SPDs EUS-GJ involves the passage of an ultra-thin gastroscope with a stiffening device to the jejunum beyond the obstruction. The EUS scope is then lubricated with silicon and introduced to the stomach, adjacent to the gastroscope, which remains sojourned in the jejunum for stabilization and saline infusion. A long guidewire is then advanced through a 19 gauge needle and grasped by a snare passed through the jejunal scope to create a safe-track and support the lumen-apposing stent to create GJ (figure 1). We performed a single-center comparative cohort study of patients with GOO who received EUS-GJ though standard antegrade approach compared to the SPDs approach. The primary outcome was technical success rate. Secondary outcomes were clinical success and adverse events. We used Fisher’s exact test for the analysis. We included a total of 21 patients with GOO. The mean age was 63.9 ± 8.7 years, with 40% females. The majority had malignant gastric outlet obstruction (86%). Seven patients (35%) had previous enteric stenting without clinical success. We performed EUS-GJ using the SPDs technique in 12 patients and standard antegrade techniques in 9 patients. We achieved technical success in all cases with SPDs 12/12 (100%) and 8/9 (88.9%) with antegrade techniques (p= 0.43). The single failure in the standard antegrade technique arm was salvaged successfully with SPDs approach. Clinical success was achieved in 93% of patients with follow-up. One patient died one week after the EUS-GJ due to advanced cancer, and we were not able to ascertain clinical success, though cross-sectional imaging did show patent EUS-GJ without complications. Serious adverse events requiring intervention developed in 2 patients in the SPDs group (16.6%); one partial stent migration and leak 48 hours after the procedure requiring surgical repair and one requiring endoscopic adjustment. One serious AE reported in the standard antegrade approach (11%); stent deployment into the peritoneum requiring endoscopic repair. There was no significant difference between the two techniques in serious AE, P=0.65. The SPDs EUS guided GJ is a safe and technically feasible technique for palliation of GOO. Given its advantages of small-bowel stabilization and the creation of safe passage, it should be utilized when standard antegrade techniques fail or if an optimal access window is not achieved.