Endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stent: an animal study comparison of wireless and over-the-wire techniques.

EUS-guided gastroenterostomy (EUS-GE) proved efficacy and safety for the management of gastric outlet obstruction (GOO). Nevertheless, lack of standardization and lumen-apposing metal stent (LAMS) misdeployment are limiting its spread. The aim was to compare the wireless endoscopic simplified technique (WEST) and the direct technique over a guided-wire (DTOG) and to evaluate patency and maximal anastomotic tensile strength (MATS) after LAMS-in-LAMS salvage therapy. A prospective animal study was performed comparing DTOG and WEST techniques. After performing an EUS-GE, LAMS-in-LAMS was performed to treat involuntary or voluntary LAMS misdeployment. The animals were followed during 12 weeks. Primary endpoints included technical success, safety and easiness of the EUS-GE, while secondary endpoints included patency and MATS of the anastomosis. 11 EUS-GE were performed in 10 living pigs. The WEST had a high technical success (100% vs. 60%; p = 0.180), less voluntary misdeployment (33.3% vs. 100%, p = 0.060), a better easiness score (7/10 vs. 1/10; p < 0.01) and better technical outcomes (number of attempts and procedure duration) compared to DTOG. Concerning LAMS-in-LAMS, technical success was 81.8%. At week 10 LAMS were removed and at week 12, the anastomosis diameter was reduced by an average of 1.85 mm [range 0-9.5 mm]. The mean MATS was 27.46 ± 5.07 N. WEST resulted in higher technical success as compared to DTOG to create EUS-GE. In case of LAMS misdeployment, the LAMS-in-LAMS proofed to be a reliable rescue therapy with a good anastomotic patency and tensile strength.