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ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY USING A PARALLEL ENTERIC TUBE FOR LUMINAL DISTENSION: PROSPECTIVE MULTICENTER PROCEDURAL STANDARDIZATION

Carlos Chavarría Herbozo 1, Vanessa Matin-Alvarez 1, Jose Ramon Aparicio Tormo 2, Jose Carlos Subtil 3, Francisco Javier Garcia-Alonso 1, Juan Jose Vila 4, Belén Martínez Moreno 2, Victoria Busto 5, Ramón Sánchez-Ocaña 1, Carlos De La Serna Higuera 1, Manuel Pérez-Miranda 1

Affiliations

1 Hospital Universitario Rio Hortega, Valladolid, Spain

2 Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica ISABIAL, Alicante, Spain

3 Clínica Universitaria de Navarra, Navarra, Spain

4 Hospital Universitario de Navarra, Pamplona, Spain

5 Hospital Universitario de Navarra, Navarra, Spain

Summary

AI Generated

A prospective multicenter study of 65 patients standardized PET-assisted endoscopic ultrasound-guided gastroenterostomy into 4 tasks and 10 subtasks, achieving 98.5% technical success with similar outcomes between expert and non-expert advanced endoscopists.

Technical success was 98.5% and clinical success was 83.3%, with adverse events in 15.4% of patients (2 mild, 7 moderate, 1 severe) and no difference in success or adverse event rates between expert and non-expert endoscopists.
The procedure was standardized into 4 tasks (PET placement, endoscope exchange, small bowel distention and targeting, LAMS placement) with 5 essential subtasks having established methodology including guidewire and PET placement, endoscope exchange, delivery system insertion and LAMS deployment.
Median procedure time was 26.2 minutes overall, but non-experts required longer procedure times (35 vs 21.8 minutes, p<0.001) and higher injected fluid volumes (510 vs 415 ml, p=0.01) compared to experts.
The study included 65 consecutive adult patients with unresectable malignant gastric outlet obstruction treated by seven endoscopists between August 2019 and April 2021 across multiple centers.

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Abstract

Introduction

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) offers advantages over duodenal stenting and surgical bypass. EUS-GE technique, however, remains non-standardized. A parallel enteric tube (PET) facilitates luminal distention, a critical step during EUS-GE.

Aims & Methods

We primarily aimed at standardizing PET-assisted EUS-GE, secondarily assessing reproducibility and outcomes.
Prospective multicenter study on consecutive adult patients with unresectable malignant gastric outlet obstruction undergoing primary EUS-GE between August 2019-April 2021. Hierarchical task analysis predefined procedural steps into tasks and subtasks. Subtasks were further categorized into essential (performed in all centers and in over 85% of the procedures) or optional. Subtask methodology was considered established if performed similarly in all centers or variable if not. Procedure times, injected fluid volume, luminal diameters obtained, accessories used, and clinical outcomes were recorded.

Results

Seven endoscopists performed EUS-GE in 65 patients (50.8% male, median [IQR] age 77.5 [65.7-86.5] years). EUS-GE was categorized into 4 tasks and 10 subtasks (Table 1). Five essential subtasks involved an established methodology (guidewire and PET placement, endoscope exchange, delivery system insertion and LAMS deployment).
Technical and clinical success rates were 98.5% and 83.3%, respectively. AEs occurred in 10 (15.4%) patients (2 mild, 7 moderate, 1 severe). Success and AE rates were not different between expert and non-experts. Median (IQR) procedure time was 26.2 (19.7-37.1) min. The short and long axis of the targeted small bowel loop was 27 (23-30) x 40 (33-60) mm. Procedure time was longer (35 [30.6-43.7] vs 21.8 [16.4-29.5] min, p<0.001) and injected fluid volume higher (510 [439-870] vs 415 [255-480] ml, p=0.01) in non-experts.

Table 1. Proposed taxonomy for the PET-assisted EUS-GE

Tasks	Subtasks	Methods	Material
PET placement	Advance guidewire beyond the stricture (E)	Aim distal end past into jejunum (Es)	Three layer catheter (S) 0.025” or 0.035” guidewire
	Through the catheter enterography (O)	Enterography (V)	-
	Advance PET beyond the stricture (E)	Aim distal end next to Treitz into jejunum (Es)	R: 8.5 Fr drain
Endoscope exchange	Remove initial endoscope, advance echoendoscope (E)	Endoscopic and fluoroscopic monitoring of PET position (Es)	-
Small bowel distention and targeting	Through the PET enterography (O)	Enterography (V)	-
	Small bowel distention (E)	Saline + contrast +/- methylene blue (V)	R: Flushing pump S: Tap adaptor
	Target acquisition (E)	EUS +/- fluoroscopic guidance (V)	-
LAMS placement	Stent insertion (E)	Freehand technique, bowling water sign (Es)	R: 20x10 mm LAMS S: 15x10 mm LAMS
LAMS placement	Stent deployment (E)	Intra-channel stent release technique (Es)	-

PET: Parallel enteric tube; EUS-GE: Endoscopic ultrasound-guided gastroenterostomy; (E): Essential; (O) Optional; (Es) Established; (V): Variable; (S): Suggested; (R): (Recommended); LAMS: Lumen apposing metal stent.

Conclusion

PET-assisted EUS-GE was standardized, identifying its key steps and technique variants. PET-assisted EUS-GE appears to be a reproducible procedure among advanced endoscopists with different levels of experience. (Clinical Trials Identification Number: NCT04660695).

Disclosure

Carlos Chavarríareceived research and training support by a grant from The Foundation of the Institute of Health Sciences Studies of Castilla y León (IECSCYL).
Vanessa Martín-Álvarezhas nothing to declare.
José Ramón Aparicio is a consultant for Boston Scientific.
Jose Carlos Subtil has nothing to declare.
Francisco Javier Garcia-Alonso has nothing to declare.
Juan J. Vila is a consultant for Boston Scientific and speaker for Cook Endoscopy and Olympus.
Belén Martínez-Moreno has nothing to declare.
Victoria Busto-Bea has nothing to declare.
Ramon Sanchez-Ocaña has nothing to declare.
Carlos de la Serna-Higuera has nothing to declare.
Manuel Perez-Miranda Miranda is a consultant and speaker for Boston Scientific, Olympus, and M.I.Tech.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

Biliopancreatic endoscopy: ERCP or EUS? (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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UEG Podcast Episode

Journal Podcast

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UEG Journal Best Paper Award

Mohsan Subhani, Maria Manuela Estevinho, Malte Buchholz

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Abstract

Published

2025

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UEG Presentation

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THERAPEUTIC TARGETING OF SECRETED OSTEOPONTIN ATTENUATES THE FIBROTIC PHENOTYPE IN EXPERIMENTAL CHRONIC PANCREATITIS

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THERAPEUTIC TARGETING OF SECRETED OSTEOPONTIN ATTENUATES THE FIBROTIC PHENOTYPE IN EXPERIMENTAL CHRONIC PANCREATITIS

Emine Gökce 1, Lindsey Devisscher 2, Niki Rashidian 1, Pieter Hindryckx 1

Affiliations

1 Ghent University Hospital, Ghent, Belgium

2 Ghent University, Ghent, Belgium

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Abstract

Introduction

Chronic pancreatitis (CP) is a progressive and irreversible fibro-inflammatory disease of the pancreas, characterized by acinar loss and fibrosis, for which no curative therapy exists. Secreted osteopontin (sOPN) is a matricellular cytokine increasingly recognized as a key mediator of fibrosis in multiple organs, including the liver, lung and pancreas. However, its potential as a therapeutic target in CP remains unexplored.

Aims & Methods

This study investigated whether sOPN contributes to pancreatic fibrogenesis in experimental CP. CP-like injury was induced in mice by six intraperitoneal cerulein injections (50 µg/kg every hour) three days per week, combined with ethanol injections (33%, 3×/week) for 6 weeks. Anti-OPN antibody (200µg, 3×/week) was administered to neutralize secreted OPN. Serum sOPN levels were measured by ELISA. Pancreatic RNA was isolated for qPCR analysis of inflammatory and fibrotic markers, and fibrosis was additionally evaluated histologically using Sirius Red staining. Immunohistochemistry for α-SMA was performed and quantified to evaluate pancreatic stellate cell activation.

Results

Six-weekly injections of cerulein and ethanol induced a consistent CP-like phenotype, characterised by acinar cell loss, inflammatory cell infiltration and fibrosis. Circulating sOPN levels were significantly higher in mice with CP compared to healthy mice, and significantly decreased upon anti-OPN-Ab treatment (Δ = -98514; 95% CI -180392 to -16636; p = 0.0209). Histological analysis showed a significant reduction in pancreatic fibrosis, with less collagen deposition on Sirius Red staining (Δ = -1.648, 95% CI -2.766 to -0.530; p = 0.0064). Immunohistochemical analysis of α-SMA also showed a significant reduction, suggesting decreased pancreatic stellate cell activation (Δ = -3.636; 95% CI -5.351 to -1.920; p = 0.0004). Pancreatic α-SMA and CTGF mRNA expression showed a significant reduction after OPN blockade (α-SMA: Δ = -72.91; 95% CI -117.8 to -28.04; p = 0.0028; CTGF: Δ = -3.112; 95% CI -5.542 to -0.681; p = 0.0147), accompanied by significant downregulation of pro-fibrotic genes, including Col1a1 (Δ = -6.467; 95% CI -11.02 to -1.911; p = 0.0077), Col3a1 (Δ = -5.097; 95% CI -8.201 to -1.994; p = 0.0026), and MMP2 (Δ = -2.659; 95% CI -5.318 to -0.0002; p = 0.0500), indicating attenuation of the fibrotic phenotype.

Conclusion

Blocking secreted OPN significantly reduced serum OPN levels, markers of pancreatic stellate cell activation, and markers of fibrogenic gene expression in experimental CP. Additionally, histology showed significantly less collagen deposition, identifying secreted OPN as a potential therapeutic target in CP.

Event

UEG Week Barcelona 2026

Topics

Gut Microbiota Endoscopy Radiology & Imaging Pancreas

Submission format

Abstract

Session

Chronic pancreatitis

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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MASH with Liver Fibrosis: From Growing Burden to Targeted Treatment (Madrigal Pharmaceutical) (Complete Session)

Laurent Castera 1, Münevver Demir 2, David Marti Aguado 3

Affiliations

1 Hôpital Beaujon - Service d’Hépatologie, Hôpital Beaujon; Clichy/FR, Clichy, France

2 Charité - Universitätsmedizin, Berlin, Germany

3 Hospital Clínico Universitario de Valencia, Valencia, Spain

Summary

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Abstract

Publisher

Madrigal Pharmaceuticals

Event

UEG Week Barcelona 2026

Session

MASH with Liver Fibrosis: From Growing Burden to Targeted Treatment (Madrigal Pharmaceutical)

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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The transition from acute to chronic pancreatitis: Can we stop it?

Bálint Erőss 1

Affiliations

1 Semmelweis University, Budapest, Hungary

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Endoscopy Pancreas

Session

Life after acute pancreatitis: Risks, surveillance and management

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

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What are the opportunities for endoscopic therapy?

George Webster 1

Affiliations

1 University College Hospital, London, United Kingdom

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Surgery Pancreas Endoscopy

Session

Daily questions in the management of chronic pancreatitis

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Pancreatic resection: How much to cut?

Ihsan Ekin Demir 1

Affiliations

1 Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Surgery Pancreas Endoscopy

Session

Daily questions in the management of chronic pancreatitis

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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UEG Journal Best Paper Award

Maria Manuela Estevinho

THERAPEUTIC TARGETING OF SECRETED OSTEOPONTIN ATTENUATES THE FIBROTIC PHENOTYPE IN EXPERIMENTAL CHRONIC PANCREATITIS

Pieter Hindryckx

MASH with Liver Fibrosis: From Growing Burden to Targeted Treatment (Madrigal Pharmaceutical) (Complete Session)

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