Post written by Bachir Ghandour, MD, from Johns Hopkins Medicine, Baltimore, Maryland, USA.
EUS-guided gastroenterostomy (EUS-GE) is a minimally invasive procedure that is increasingly performed for the management of patients with gastric outlet obstruction (GOO). Stent misdeployment (SM) during EUS-GE remains the most common cause for technical failure and adverse events, hindering its widespread dissemination.
Although SM can lead to severe outcomes, we hypothesized that most SMs can be managed endoscopically without ill consequences. This current study aimed therefore to evaluate the rate of SM during EUS-GE, classify the different types of SM, and compare the severity, management, and outcomes according to the proposed classification.
It was important to conduct this study because there were no studies reporting on the outcomes and management of SM during EUS-GE. Data on SM were limited to case series reporting on the procedural outcomes of patients undergoing EUS-GE for GOO management, where the observed rate of SM greatly varied from 6.8% to 27%. Furthermore, even though SM can occur in different ways depending on which flange was misdeployed and the location of misdeployment, there was no consistent description of the specific type of SM to occur. We believed that proposing a new classification system for the types of SM can facilitate standardization of terms for future research.
Our study found that although SM was not infrequent during EUS-GE, with a rate of approximately 10%, most cases are mild in severity and can be managed or repaired endoscopically without ill consequences. Surgical intervention was required in less than 11% of cases. Also, according to our new proposed classification system, type I SM was found to be the most common, with evidence that it could be associated with better outcomes, as compared with type II.
The findings described in this case will need to be validated in future studies. We believe that our proposed classification system and the standardization of the terms used for the different types of SM to occur can facilitate both conducting research and exchanging information reporting on EUS-GE, an approach for the management of GOO patients.
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