EUS-guided gastroenterostomy with lumen-apposing 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 (LAMS) appears to be effective and safe in gastric outlet obstruction (GOO). However, the EUS-GE procedure is not standardized. The use of assisted or direct methods is still debated. The aim of this study was to compare the outcomes of EUS-GE techniques with focus on assisted with a oro-intestinal drain wireless endoscopic simplified technique (WEST) and the non-assisted direct technique over a guidewire (DTOG). Patients This is a multicenter European retrospective study including four tertiary centers. Consecutive patients who underwent EUS-GE between August 2017 and May 2022 for GOO 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 A total of 71 patients (66.2±10 years, 42.3% male, 80.3% malignant etiology) were included. Technical success was higher in the WEST group (95.1% vs. 73.3%, eRR:3.2; 95%CI [0.94; 10.9], p=0.014). 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). The clinical success was comparable in the two groups at one month (97.5% vs. 89.3%). The median follow-up was 5 months (range 1-57). Conclusion The WEST has a higher technical success and less AEs, with a clinical success comparable to the DTOG. Therefore, the WEST technique (with an oro-intestinal drain) should be preferred to perform EUS-GE.