Endoscopic ultrasound guided gastrojejunostomy for gastric outlet obstruction

Table 1 Etiology of gastric outlet obstruction[1,2]

Malignant causes	Benign causes
Pancreatic cancer	Peptic ulcer
Gastric cancer	Hypertrophic pyloric obstruction
Cholangiocarcinoma	Gastric polyp
Gallbladder cancer	Caustic ingestion
Duodenal cancer	Iatrogenic
Ampullary cancer	Gastric/duodenal tuberculosis
Other1	Prepyloric web

¹Non-Hodgkin’s lymphoma, intraabdominal small cell sarcoma; metastatic and/or primary tumors of the lung, breast, ovary, kidney, urinary tract or colon; and tumor around the head of the pancreas

Table 2 Gastric outlet obstruction scoring system[3]

Level of oral intake	Score
No oral intake	0
Liquids only	1
Soft solids	2
Low residue or full diet	3

Table 3 Types of lumen-apposing metal stents[27-29]

Stent	Flange diameter (mm)	Length (mm)	Lumen diameter (mm)	Electrocautery enhanced option	Material
AXIOSTM (Boston Scientific Corp., Marlborough, MA, United States)	21, 24, 29	10	10, 15, 20	Yes	Silicone-covered, nitinol-braided stent
NAGITM (Taewoong Medical Co., Ltd., Goyang, South Korea)	20	10, 20, 30	10, 12, 14, 16	No	Silicone-covered, Nitinol stent
Niti-S SpaxusTM stent (Taewoong Medical Co., Ltd.)	23, 25, 31	20	8, 10, 16	Yes	Silicone-covered, Nitinol stent
HANAROTM stent (M.I.Tech, Pyeongtaek, South Korea)	22 - 28	10, 30	10, 12, 14, 16	No	Silicone-covered, Nitinol stent

Table 4 Outcomes of endoscopic ultrasonography-guided gastroenterostomy using a lumen-apposing self-expandable metal stent in benign and malignant gastric outlet obstruction[27,30,35-40]

	Itoi et al[30]	Tyberg et al[35]	Chen et al[36]		Kerdsirichairat et al[38]	Ge et al[37]	Jovani et al[39]	Wannhoff et al[27]	James et al[40]
Type of study	Single-center, Prospective	International, Retrospective	Multicenter, Retrospective		Single-center, Retrospective	Single-center, Retrospective	Single-center, Retrospective	Single-center, Retrospective	Single-center, Retrospective
Number of patients (n)	20	26	74		57	22	73	35	22
Number of malignant obstructions	20	17	49		48	22	64	33	0
Number of benign obstructions	0	9	25		9	0	9	2	22
EUS-GJ technique, n	EPASS n = 20	Direct n = 3, Balloon-assisted n = 13, Nasobiliary n = 3, Ultraslim scope n = 5, NOTES n = 2	Direct n =52	Balloon-assisted n = 22	Direct n = 57	Direct n = 24	Direct n = 73	Direct n = 22, Nasobiliary n = 10, other = 3	Direct n = 9, Orojejunal = 5, Balloon-assisted = 8
Technical success (%)	90	92	94.2	90.9	92.9	100	93	80	95.4
Clinical success (%)	NA	85	92.3	90.9	89.5	95.8	97	74.3	NA
Adverse events (%)	10	11.5	5.8	9.1	3.5	20.8	7.4	14.3	19
Recurrence/need for Reintervention (%)	NA	3.8	5.8	18.2	15.1	8	15	NA	23.8

EUS-GJ: Endoscopic ultrasound guided gastrojejunostomy; EPASS: Endoscopic ultrasonography-guided double balloon-occluded gastrojejunostomy bypass; NOTES: Natural orifice transluminal endoscopic surgery; NA: Not applicable.

Table 5 Outcomes of endoscopic ultrasonography-guided gastroenterostomy using a lumen-apposing self-expandable metal stent as compared to surgery[41,42]

	Khashab et al[41]		Perez-Miranda et al[42]
Type of study	Multicenter, retrospective		Multicenter, retrospective
Group	EUS-GJ	Surgery	EUS-GJ	Laparoscopic GJ
Number of patients, n (%)	30/93 (32.3)	63/93 (67.7)	25/54 (46.3)	29/54 (53.7)
Technique	Direct; EPASS; Balloon-assisted	Open GJ2	Direct Assisted	Laparoscopic GJ
Technical success (%)	87	100	88	100
Clinical success (%)	87	90	84	90
Adverse events (%)	16	25	12	41
Recurrence/need for Reintervention (%)	3	14	NA	NA

EUS-GJ: Endoscopic ultrasound guided gastrojejunostomy; GJ: Gastrojejunostomy; EPASS: Endoscopic ultrasonography-guided double balloon-occluded gastrojejunostomy bypass; NA: Not applicable.

Table 6 Outcomes of endoscopic ultrasonography-guided gastroenterostomy using a lumen-apposing self-expandable metal stent as compared to duodenal stenting[37,43]

	Chen et al[43]		Ge et al[37]
Type of study	Multicenter, retrospective		Single center, retrospective
Group	EUS-GJ	Duodenal stenting	EUS-GJ	Duodenal stenting
Number of patients, n (%)	30 (36.5)	52 (63.4)	22 (22)	78 (78)
Technique	Direct; EPASS; Balloon-assisted	Uncovered Wallflex (Boston Scientific)	Direct Assisted	Uncovered WallFlex; Boston Scientific, or (Evolution; Cook Medical)
Technical success (%)	86.7	94.2	100	100
Clinical success (%)	83.3	67.3	95.8	76.3
Adverse events (%)	16.7	11.5	20.8	40.2
Recurrence/need for Reintervention (%)	4.0	28.6	8	32

EUS-GJ: Endoscopic ultrasound guided gastrojejunostomy; EPASS: Endoscopic ultrasonography-guided double balloon-occluded gastrojejunostomy bypass.