APDW 2018 Plenary Oral Presentations

Background and Aims: EUS gastrojejunostomy GJ is emerging as an alternative novel technique in patients with symptomatic gastric outlet obstruction GOO. Methods: 5 patients with symptomatic gastric outlet obstruction underwent EUS-guided GJ interventions from May 2017 to Nov 2017. Technical success was defined as successful deployment of lumen apposing metal stents (LAMS), while clinical success was the ability to tolerate diet. Results: Median age was 61.5 (range 53–83) years. GOO was secondary to advanced pancreatic malignancy (4) and duodenal malignancy (1). Two patients had altered anatomy from previous post Billroth gastrectomy and Roux-en-Y hepaticojejunostomy. For all five patients with GOO, LAMS 15 mm diameter with electrocautery-enhanced delivery system was used to create the GJ anastomosis. Identification of the distal jejunal limb was done with an inflated balloon catheter, and this was used as a target for direct puncture with a 19G needle. All five interventions had technical success with median procedure time of 80 min (38–163 range). All stents were dilated up to their corresponding diameters. Duration of stay after procedure was 3–7 days, and there were no adverse events post procedure such as bleeding or perforation. There were no stent migrations, and stents were left in place for the rest of their life expectancy. One patient developed intermittent vomiting 4 weeks after stent deployment. This was possibly secondary to proximal stomach deployment, as repeated endoscopy showed a patent stent. The rest of the patients had clinical success and could tolerate diet on discharge. Range of follow-up time was 1–6 months, and at time of analysis, GOO did not recur in all 5 patients. Three patients died due to disease progression with no symptoms of GOO prior to terminal event. Conclusion: EUS guided GJ is a novel procedure with favorable outcomes in patients with symptomatic GOO.