Classification, outcomes, and management of misdeployed stents during EUS-guided gastroenterostomy.
Por:
Ghandour B, Bejjani M, Irani SS, Sharaiha RZ, Kowalski TE, Pleskow DK, Do-Cong Pham K, Anderloni AA, Martinez-Moreno B, Khara HS, D'Souza LS, Lajin M, Paranandi B, Subtil JC, Fabbri C, Weber T, Barthet M and Khashab MA
Publicada:
1 ene 2022
Ahead of Print:
3 ago 2021
Resumen:
BACKGROUND AND AIMS: Stent misdeployment (SM) has hindered the dissemination of EUS-guided gastroenterostomy (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 in the United States, 8 in 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 American Society for Gastrointestinal Endoscopy lexicon), whereas secondary outcomes were clinical outcomes and management of dislodgement according to the SM classification type, in addition to salvage management of GOO after SM. RESULTS: From 467 EUS-GEs performed for GOO during the study period, SM occurred in 46 patients (9.85%). Most SMs (73.2%) 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 patients (10.9%) 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 = .04) despite an equivalent rate of surgical repair (10.3% vs 7.1%, P = .7). Overall, 4 patients (8.7%) required an intensive care unit stay (median, 2.5 days). The median length of stay was 4 days after SM. CONCLUSIONS: Although SM is not infrequent during EUS-GE, most are type I, mild/moderate in severity, and can be managed endoscopically with a surgical intervention rate of approximately 11%.
Filiaciones:
Ghandour B:
Johns Hopkins Medicine, Baltimore, Maryland, USA
Bejjani M:
Johns Hopkins Medicine, Baltimore, Maryland, USA
Irani SS:
Virginia Mason Medical Center, Seattle, Washington, USA
Sharaiha RZ:
Weill Cornell Medicine, New York, New York, USA
Kowalski TE:
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
Pleskow DK:
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Do-Cong Pham K:
Department of Medicine, Haukeland University Hospital, Bergen, Norway
Anderloni AA:
Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
:
Hospital General Universitari d'Alacante, Alicante, Communidad Valenciana, Spain
Khara HS:
Geisinger Health, Danville, Pennsylvania, USA
D'Souza LS:
Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
Lajin M:
Sharp Grossmont Hospital, La Mesa, California, USA
Paranandi B:
Leeds Teaching Hospitals NHS Trust, Leeds, UK
Subtil JC:
Clinica Universidad de Navarra, Pamplona, Navarra, Spain
Fabbri C:
Gastroneterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forli-Cesena, Italy
Weber T:
Universitatsklinikum Augsburg, Augsburg, Bayern, Germany
Barthet M:
Service d'Hépato-gastroentérologie, Hôpital Nord, Marseille, France
Khashab MA:
Johns Hopkins Medicine, Baltimore, Maryland, USA
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