Long-term outcomes of EUS-guided gastroenterostomy: a large, single center experience.

INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is effective and safe in benign and malignant indications. However, there is a paucity of literature on the outcomes of these patients. Our study evaluates the long-term outcomes of patients who underwent EUS-GE and stent-related adverse events (AEs). METHODS: This retrospective study took place at a tertiary-care institution from January 1, 2014 to December 31, 2022. Patients who underwent EUS-GE were included. Procedure details and outcomes were recorded. Patients were followed for at least 3 months after the procedure. RESULTS: A total of 207 patients (50.3% male, mean age 62.3 years) underwent EUS-GE for malignant (N=117, 56.5%) and benign (N=90, 43.5%) indications. Overall technical success was 95.7%. Patients were followed for a mean of 406 days. Stents were removed in 25.6% of patients; common reasons include completed access for endoscopic retrograde cholangiopancreatography (ERCP) (N=13, 25%), resection/resolution of gastric outlet obstruction (GOO) (N=28, 53.8%), and surgical resection of malignant GOO (N=8, 15.4%). EUS-GE stents remained in place in 63.6% of patients for ≥3 months and in 21% of patients for ≥1 years. Late AEs occurred in 3.4%. Among patients who were stent-dependent (N=24, 11.6%) and underwent annual stent exchanges, no late AEs occurred. DISCUSSION: Long-term outcomes of EUS-GE are promising with few adverse events, particularly with preemptive annual exchanges of stents to prevent stent delamination and occlusion among patients who require long-term indwelling stents. EUS-GE has an increasing role in access for ERCP in altered anatomy, acute or chronic management of benign GOO, or bridge to definitive surgery for GOO.