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        Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction

        Ryosuke Tonozuka,Takayoshi Tsuchiya,Shuntaro Mukai,Yuichi Nagakawa,Takao Itoi 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.5

        Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality oflife. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent(LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GEtechnique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslimendoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS haveshown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studiescomparing EUS-GE and surgical astrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, witha lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.

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