Gastrointestinal endoscopy · 2026
Long-term outcomes of endoscopic ultrasound-guided gastroenterostomy: a prospective cohort study tracking symptom recurrence, reintervention timelines, and stent modifications over time.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Vanella Giuseppe, Frigo Francesco, Perelli Francesca, Barà Rukaia, Leone Roberto, Stasio Rosa Claudia, Maisonneuve Patrick, Partelli Stefano, Aleotti Francesca, Orsi Giulia, Macchini Marina, Balzano Gianpaolo, Reni Michele, Falconi Massimo, Capurso Gabriele, Arcidiacono Paolo Giorgio
Аннотация
BACKGROUND AND AIMS: Limited information is available on long-term outcomes of EUS-guided gastroenterostomy (EUS-GE) and modifications of lumen-apposing metal stents (LAMSs) over time.
METHODS: All consecutive EUS-GEs for malignant indications between 2020 and 2024 were enrolled in a single-center prospective registry (Prospective Registry of Therapeutic, ClinicalTrials.gov NCT04813055). The primary outcomes were EUS-GE dysfunctions and dysfunction-free survival (DyFS) using Kaplan-Meier curves. Endoscopic and radiologic reassessments were used to estimate local modifications and LAMS diameter over time (linear regression).
RESULTS: A total of 166 EUS-GEs (median age 66 [IQR, 60-73] years; male 53.6%; pancreatic cancer, 74.1%) were included. A 20-mm LAMS dilated to 18 mm was used in 98.8%. Technical and clinical success rates were 98.8% and 95.7%, respectively. Adverse events were registered in 16.3% (procedure-related, 7.2%). Over a median follow-up of 128 (64-245) days, symptom recurrence occurred in 11%, but was related to EUS-GE dysfunctions in 13 of 154 cases (8.4%), after a median of 209 (85-347) days. All endoscopic reinterventions were successful. Estimated DyFS at 6 and 12 months was 96.7% and 82%, respectively. At endoscopic re-evaluations (47 patients, 61 endoscopies), peri-LAMS tissue reactions were observed in 38.3% after 269 (79-390) days whereas LAMS modifications (mostly ingrowth) were observed in 19.1% after 421 (231-560) days. Radiologic follow-up (89 patients, 168 CT scans) revealed a reduction in LAMS diameter of ≈0.21 mm ± 0.03 every month (F test; P < .0001).
CONCLUSIONS: Clinically overt EUS-GE dysfunctions are rare and successfully endoscopically amenable, discouraging scheduled surveillance in malignancies. However, LAMSs show predictable narrowing, sustained by subclinical local reactions, which might inform surveillance in benign indications.
METHODS: All consecutive EUS-GEs for malignant indications between 2020 and 2024 were enrolled in a single-center prospective registry (Prospective Registry of Therapeutic, ClinicalTrials.gov NCT04813055). The primary outcomes were EUS-GE dysfunctions and dysfunction-free survival (DyFS) using Kaplan-Meier curves. Endoscopic and radiologic reassessments were used to estimate local modifications and LAMS diameter over time (linear regression).
RESULTS: A total of 166 EUS-GEs (median age 66 [IQR, 60-73] years; male 53.6%; pancreatic cancer, 74.1%) were included. A 20-mm LAMS dilated to 18 mm was used in 98.8%. Technical and clinical success rates were 98.8% and 95.7%, respectively. Adverse events were registered in 16.3% (procedure-related, 7.2%). Over a median follow-up of 128 (64-245) days, symptom recurrence occurred in 11%, but was related to EUS-GE dysfunctions in 13 of 154 cases (8.4%), after a median of 209 (85-347) days. All endoscopic reinterventions were successful. Estimated DyFS at 6 and 12 months was 96.7% and 82%, respectively. At endoscopic re-evaluations (47 patients, 61 endoscopies), peri-LAMS tissue reactions were observed in 38.3% after 269 (79-390) days whereas LAMS modifications (mostly ingrowth) were observed in 19.1% after 421 (231-560) days. Radiologic follow-up (89 patients, 168 CT scans) revealed a reduction in LAMS diameter of ≈0.21 mm ± 0.03 every month (F test; P < .0001).
CONCLUSIONS: Clinically overt EUS-GE dysfunctions are rare and successfully endoscopically amenable, discouraging scheduled surveillance in malignancies. However, LAMSs show predictable narrowing, sustained by subclinical local reactions, which might inform surveillance in benign indications.