Su1331 PREDICTORS OF TECHNICAL AND CLINICAL SUCCESS OF ENDOSCOPIC GASTROENTEROSTOMY WITH LUMEN-APPOSING METALS STENTS

Abstract

Lumen-apposing metal stents (LAMS) can be used for creation of gastrointestinal anastomoses under endoscopic ultrasound (EUS) guidance. This technique has mostly been evaluated as treatment for gastric outlet obstruction (GOO). Aim of this study was to further evaluate success and safety of this technique as well as to identify predictors of technical success. All patients that underwent EUS-guided gastrointestinal anastomosis with LAMS in our endoscopy unit between February 2016 and August 2019 were identified and evaluated retrospectively. Details on the endoscopic technique and on basic demographic and health characteristics were obtained by chart review and included in the study. Technical success was defined as successful insertion of the LAMS. In patients with GOO, an improvement ≥ 1 point in the GOO score (GOOS) was defined as clinical success. Thirty-five patients were included in the study. Twenty-two patients (62.9%) were female and the median age was 79 years (range: 32 – 93). Indication for the anastomosis was malignant GOO in 33 patients (94.3%). In one patient each the indication for the anastomosis was treatment of efferent loop syndrome and access for endoscopic retrograde cholangiography (ERC) after previous hepaticojejunostomy with Roux-en-Y reconstruction. In 10 patients the LAMS was inserted over a guidewire, in 22 patients direct puncture with the electrocautery delivery system of the LAMS was performed. In two patients other techniques were used. The overall technical success rate was 80.0%; in four patients two attempts were necessary to successfully create the anastomosis. The main reason for technical failure was dislocation of the distal flange in 4 patients (57.1%). Clinical success rate was 74.3% in the study population and 92.3% in patients with malignant GOO and technically successful creation of the anastomosis. The procedure as well resulted in clinical success in the two patients that underwent EUS-guided anastomosis for treatment of efferent limp syndrome and as access route for ERC. Adverse events occurred in 14.3%. Technical success increased and procedure time decreased significantly during the study period. The distance between the two lumina that were connected with the LAMS was significantly shorter (median: 9 mm) in patients with technical success compared to those without (median: 20 mm, P = 0.004). This distance was identified as predictor of success on multivariate analysis (Figure). Technical success of EUS-guided gastrointestinal anastomosis with LAMS mainly depends on the distance between the two lumina that are going to be connected by the LAMS. It is also influenced by the endoscopist’s experience. Overall this technique presents a promising and emerging treatment option, especially for patients with malignant GOO.