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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2020; 74(4): 302–310. doi:10.14735/amgh2020302.

EUS-guided gastrointestinal anastomosis – new possibilities of therapeutic endoscopy

Vladimír Nosek1, Jiřina Pintová2

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Endosonographic guided gastroenteroanastomosis (EUS-GEA) with lumen apposing metal stents is a novel alternative of treating malignant and benign gastric outlet obstruction (GOO). EUS-GEA can also be used to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy of the upper gastrointestinal tract.
We performed a retrospective analysis of 25 consecutive patients with endoscopically formed gastrointestinal anastomoses. We separately analyzed 20 patients with GOO and five patients with biliary obstruction and surgically altered anatomy in whom enteroscopy-assisted ERCP had failed. Primarily, we evaluated technical feasibility, clinical efficiency and complications.
In a group of 20 patients with GOO, technical feasibility was 95% (19/20) and clinical efficacy was 94.7% (18/19). There were no early complications. Late complications occurred in three patients (15.8%). Endoscopic reintervention was required in 5.3% of patients (1/19). Sixteen patients had malignant GOO. Ten patients died. The mean time from procedure to death was 92.5 days (32–259). In the group of five patients with surgically altered anatomy, technical feasibility to perform gastrointestinal anastomosis was 100%; it was followed by successful ERCP in 4/5 patients (80%) with no complications.
EUS-GEA can be performed endoscopically with high technical feasibility and clinical efficacy and low need for reintervention. In appropriately selected patients they are a promising alternative to surgical and radiological approaches.

Key words: endosonography – gastrointestinal anastomosis


endosonography, gastrointestinální anastomóza

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