Scientific publications
Classification, outcomes, and management of misdeployed stents during EUS-guided gastroenterostomy
Bachir Ghandour 1 , Michael Bejjani 1 , Shayan S Irani 2 , Reem Z Sharaiha 3 , Thomas E Kowalski 4 , Douglas K Pleskow 5 , Khanh Do-Cong Pham 6 , Andrea A Anderloni 7 , Belen Martinez Moreno 8 , Harshit S Khara 9 , Lionel S D'Souza 10 , Michael Lajin 11 , Bharat Paranandi 12 , Jose Carlos Subtil 13 , Carlo Fabbri 14 , Tobias Weber 15 , Marc Barthet 16 , Mouen A Khashab 17 , EUS-GE study-group
Background and aims: Stent misdeployment (SM) has hindered the dissemination of EUS-GE for gastric outlet obstruction (GOO) management. We aimed to provide a classification system for SM during EUS-GE and study clinical outcomes and management accordingly.
Methods: This is a retrospective study involving 16 tertiary-care centers (8 United States, 8 Europe) from March 2015 to December 2020. Patients who developed SM during EUS-GE for GOO were included. We propose classifying SM into 4 types. The primary outcome was rate and severity of SM (per ASGE lexicon). Secondary outcomes included clinical outcomes and management of dislodgement according to the SM classification type, in addition to salvage management of GOO after SM.
Results: From a total of 467 EUS-GEs performed for GOO during the study period, SM occurred in 46 (9.85%) patients. The majority (73.2%) of SMs occurred during the first 13 EUS-GE cases by the performing operators. SM was graded as mild (n=28, 60.9%), moderate (n=11, 23.9%), severe (n=6, 13.0%), or fatal (n=1, 2.2%), with 5 (10.9%) patients requiring surgical intervention. Type I SM was the most common (n=29, 63.1%), followed by Type II (n=14, 30.4%), Type IV (n=2, 4.3%) and Type III (n=1, 2.2%). Type I SM was more frequently rated as mild compared with type II SM (75.9% vs 42.9%, p=0.04), despite an equivalent rate of surgical repair (10.3% vs 7.1%, p=0.7). Overall, 4 (8.7%) patients required ICU stay (median 2.5 days). The median length of stay was 4 days after SM.
Conclusions: Although SM is not infrequent during EUS-GE, the majority are Type I, mild/moderate in severity, and can be managed endoscopically with a surgical intervention rate of approximately 11%.
CITATION Gastrointest Endosc. 2022 Jan;95(1):80-89. doi: 10.1016/j.gie.2021.07.023. Epub 2021 Aug 3.
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