ASGE Therapeutic EUS for Advanced Endosonographers (On-Demand) | September 2022-8 Wagh_EUS Guided Gastrojejunostomy and Gallbladder Drainage

8 Wagh_EUS Guided Gastrojejunostomy and Gallbladder Drainage

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This document discusses EUS-guided gastrojejunostomy (EUS-GE) and EUS-guided gallbladder drainage (EUS-GBD), including their techniques, outcomes, and comparisons with other procedures. EUS-GE is a novel procedure used to circumvent the limitations of endoscopic enteral stenting in malignant gastric outlet obstruction (GOO), offering sustained patency without tumor ingrowth. The procedure involves identifying the target, accessing the target, and placing stents. Multiple studies have shown the efficacy of EUS-GE over the last decade. Comparisons between EUS-GE and surgical gastrojejunostomy have shown similar technical and clinical success rates, with significantly lower adverse events in the EUS-GE group. EUS-GE has also been compared to enteral stenting, showing comparable effectiveness and safety with fewer symptom recurrences and re-interventions. <br /><br />Regarding EUS-GBD, it is indicated for high-risk patients who are not candidates for cholecystectomy. The technique has evolved from using plastic stents to covered biliary self-expandable metal stents (SEMS) and single-step lumen-apposing metal stents (LAMS). Comparisons have been made between EUS-GBD and percutaneous cholecystostomy (PT-GBD) and ERCP-guided transpapillary gallbladder stenting (ETP-GBD). Studies have shown that EUS-GBD reduces adverse events, re-interventions, and unplanned readmissions compared to PT-GBD. EUS-GBD has also been found to have lower complication rates, shorter hospital stays, and fewer unplanned admissions compared to TP-GBD. Overall, EUS-GBD with LAMS has shown better outcomes and lower adverse events compared to other methods.<br /><br />It is important to note that EUS-guided interventional endoscopy requires high technical skills and should be performed by experienced endosonographers. The choice of procedure should be tailored based on the patient's clinical scenario, status, and available resources. EUS-guided procedures offer less invasive options with similar efficacy to surgical approaches.

Keywords

EUS-guided gastrojejunostomy

EUS-guided gallbladder drainage

endoscopic enteral stenting

malignant gastric outlet obstruction

sustained patency

surgical gastrojejunostomy

enteral stenting

high-risk patients

cholecystectomy

biliary self-expandable metal stents