Endoscopic ultrasound- guided gastroenterostomy with lumenapposing metal stents: a retrospective multicentric comparison of wireless and over-the- wire techniques

Background Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMSs) appears to be effective and safe in gastric outlet obstruction ( GOO); however, the EUS- GE procedure is not standardized, with the use of assisted or direct methods still debated. The aim of this study was to compare the outcomes of EUS- GE techniques focusing on an assisted with orointestinal drain wireless endoscopic simplified technique ( WEST) and the nonassisted direct technique over a guidewire (DTOG). Method This was a multicenter European retrospective study involving four tertiary centers. Consecutive patients who underwent EUS-GE for GOO between August 2017 and May 2022 were included. The primary aim was to compare the technical success and adverse event (AE) rates of the different EUS-GE techniques. Clinical success was also analyzed. Results 71 patients ( mean [SD] age 66.2 [10] years; 42.3% men; 80.3% malignant etiology) were included. Technical success was higher in the WEST group (95.1% vs. 73.3%; estimate of relative risk from odds ratio (eRR) 3.2, 95 % CI 0.94-10.9; P = 0.01). The rate of AEs was lower in the WEST group (14.6% vs. 46.7%; eRR 2.3, 95 % CI 1.2- 4.5; P = 0.007). Clinical success was comparable between the two groups at 1 month (97.5% vs. 89.3%). The median followup was 5 months (range 1-57). Conclusion The WEST resulted in a higher technical success rate with fewer AEs, with clinical success comparable with the DTOG. Therefore, the WEST (with an orointestinal drain) should be preferred when performing EUS-GE.