Colon to Rectum
Endoscopy. 2025;57(1):77-82
Endoscopic ultrasound-guided entero-colostomy with lumen-apposing metal stent as a rescue treatment for malignant intestinal occlusion: A multicenter study
Background: Surgery is the first-choice treatment for malignant intestinal obstruction (MIO); however, many patients are deemed unfit for surgery. Endoscopic ultrasound-guided entero-colostomy (EUS-EC) with a lumen-apposing metal stent (LAMS) could represent a new treatment option.
Methods: Consecutive patients undergoing EUS-EC for MIO from November 2021 to September 2023 at 4 European tertiary referral centers were retrospectively enrolled. Multidisciplinary meetings determined whether patients were unsuitable for surgery or colonic stent placement, or refused surgery. The primary outcome was technical success of EUS-EC and secondary outcomes were clinical outcome, safety, and hospital stay.
Results: 12 patients were enrolled (median age 72.5 [range, 42–85] years; 58.3% female). Colonic adenocarcinoma was the primary tumor in 75.0% of patients and 91.7% had stage 4 disease. Technical success was 100%. No LAMS misdeployment or other procedural adverse events occurred; 3 patients (25.0%) had severe post-procedural complications. Clinical success was achieved in 10 patients (83.3%), with 5 (50.0%) resuming chemotherapy after the procedure. Median post-procedural hospital stay was 9 (1–20) days and median overall survival was 47.5 (2–270) days.
Conclusions: Endoscopic ultrasound-guided entero-colostomy was a feasible technique and could be considered a possible alternative to standard approaches for malignant intestinal obstruction in highly selected patients.
DOI: 10.1055/a-2354-3352
PD Dr. Armin Küllmer
Head of Endoscopy, Department of Internal Medicine II, University Medical Center Freiburg (Germany)
Endoscopic entero-colostomy: connecting what belongs together
This study explores the use of endoscopic entero-enterostomy and entero-colostomy in patients with mechanical intestinal obstruction. Endoscopic anastomoses – particularly endoscopic ultrasound-guided entero-colostomy (EUS-EC) – are increasingly used for the treatment of malignant intestinal obstruction and are no longer limited to specialized centers. Compared to surgery, endoscopic approaches offer potential advantages, including reduced procedural trauma and faster patient recovery. Extending these techniques to additional indications is a logical next step in their evolution. The study by Neri et al. reports on a carefully selected patient cohort treated with a transanal approach. Its results are impressive, demonstrating a 100% technical success rate in anastomosis creation and strong clinical outcomes, with all patients resuming oral intake within 2 days.
However, the study also clearly shows a number of unresolved issues and technical challenges. These include limited access routes, the difficulty of accurately identifying target segments without risking short bowel syndrome, and the management of infectious complications. Three of 12 patients developed sepsis, 2 of them with a fatal outcome, despite successful stent placement and the physicians’ high level of expertise. Given the availability of alternative treatments such as surgery and intraluminal stent placement (albeit both with limitations), this promising novel approach should be reserved for selected patients who are not candidates for surgery or who decline surgical intervention. Thorough patient counseling and individualized decision-making are essential. Despite these limitations, the study shows significant potential for preserving quality of life in palliative care settings.