Long-term outcomes of endoscopic ultrasound-guided gastroenterostomy: a prospective cohort study tracking symptom recurrence, reintervention timelines, and stent modifications over time.

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.