ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy (On-Demand) | October 2022-13_Khashab_Malignant Gastric Outlet Obstruction Gastro Jejunostomy

13_Khashab_Malignant Gastric Outlet Obstruction Gastro Jejunostomy

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This article discusses the use of endoscopic therapy, specifically EUS-guided gastro-jejunal (GJ) bypass, as the preferred treatment for malignant gastric outlet obstruction (GOO) in 2022. The current therapy options for malignant GOO, such as surgical GJ and endoscopic stenting, have several shortcomings including invasiveness, significant morbidity, increased cost, and delays in cancer treatment. Endoscopic therapy, specifically EUS-GJ, combines the advantages of endoscopic stenting and surgical GJ without the risk of stent obstruction or tumor ingrowth/overgrowth. It also avoids the morbidity associated with surgical procedures.<br /><br />There are different techniques for EUS-GJ, including balloon-assisted EUS-GJ, direct EUS-GJ, and balloon-occluded gastrojejunostomy bypass. Procedural outcomes for EUS-GJ have been favorable, with high technical success rates and clinical success rates. Recurrent symptoms of GOO were observed in a lower percentage of patients who underwent EUS-GJ compared to those who underwent endoscopic stenting.<br /><br />The study reported a low rate of adverse events associated with EUS-GJ. However, further research is needed to fully evaluate the safety and efficacy of EUS-GJ compared to duodenal stenting and surgical GJ through ongoing prospective trials. Overall, EUS-GJ is considered a safe and effective option for palliation of malignant GOO, but it requires endoscopists with expertise in interventional EUS and experience in managing technical challenges.<br /><br />In conclusion, EUS-GJ is preferred over other treatment options for malignant GOO due to its potential for better stent patency and equivalent efficacy to surgical GJ with added advantages. However, more research is needed to confirm these findings through prospective trials.

Keywords

endoscopic therapy

EUS-guided gastro-jejunal bypass

malignant gastric outlet obstruction

surgical GJ

endoscopic stenting

EUS-GJ

balloon-assisted EUS-GJ

direct EUS-GJ

balloon-occluded gastrojejunostomy bypass

palliation of malignant GOO