EUS-guided entero-colostomy with Lumen Apposing Metal Stent as a rescue treatment for malignant intestinal occlusion: a multicentre study

Background and study aims: Surgery is the first-choice treatment for malignant intestinal obstruction (MIO), however many patients are deemed unfit for surgery. Endoscopic ultrasound guided enterocolostomy (EUS-EC) with lumen apposing metal stents (LAMS) could represent a new treatment option. Primary aim was technical success of EUS-EC. Secondary aims: clinical outcome, safety, hospital stay. Patients and methods: Consecutive patients undergoing EUS-EC for MIO from November 2021 to September 2023 were retrospectively enrolled at four tertiary referral European centres. All cases were discussed in multidisciplinary meetings, patients declared unfit for surgery, colonic stent placement or refused surgery. Results: Twelve patients were enrolled (58.3% female, median age 72.5 [42-85]). Colonic adenocarcinoma was the primary tumor in 75% of cases and 91.7% of patients had a Stage IV disease. Technical success was achieved in all procedures (100%). No LAMS misdeployment or other procedural adverse events and 3 (25%) severe post-procedural complications were observed. Clinical success was achieved in 10 (83.3%) patients, 5 (50%) resuming chemotherapy after procedure. Median post-procedural hospital stay was 9[1-20] days and overall median survival was 47.5[2-270] days. Conclusions: EUS-EC is a feasible technique and could be considered as a possible alternative to standard approaches for MIO in highly selected patients.