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INTRODUCTION: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly used in the setting of malignant gastric outlet obstruction (GOO). However, little is known about the role of primary EUS-GE. The aim of the present study is to compare the outcomes of EUS-GE by using the freehand technique as a first- and second-line approach after enteral stenting (ES). METHODS: This is an observational single-center study using a prospectively collected database. All consecutive patients who underwent an EUS-GE using the freehand technique due to malignant GOO were included. Patients with previous gastric surgery, a wire-guided EUS-GE technique, or those presenting without GOO were excluded. The primary outcome was the clinical success, defined as a solid oral intake at 1 week after the procedure (GOO Score, GOOSS ≥ 2). The secondary outcomes were technical success and adverse event (AE) rates. The impact on nutritional parameters was also assessed. RESULTS: Forty-five patients underwent an EUS-GE for all indications. Finally, 28 patients (mean age: 63 ± 17.2 years, 57.1% male) with (n = 13, 46.4%) and without (n = 15, 53.6%) a previous ES were included. The technical success was achieved in 25 cases (89.3%), with no differences between the two groups (92.3% vs. 86.7%, p = 1). The median limb diameter and procedure time were 27 mm (range:15-48) and 37 min. Overall, clinical success was achieved in 22 cases (88%), with three failures due to AEs (n = 2) or peritoneal carcinomatosis (n = 1). The diet progression was quicker in patients with a previous ES (GOOSS at 48 h, 2 vs. 1, p = 0.023), but the GOOSS at 1 week (p = 0.299), albumin gain (p = 0.366), and BMI gain (0.257) were comparable in the two groups. The AE rate was 7.1%. CONCLUSIONS: EUS-GE achieves a high technical and clinical success in patients with GOO regardless of the presence of a previous ES. Patients with previous ES may have a quicker progression of their diet, but the GOOSS and nutritional status in the long term at 1 week or 1 month are comparable. Primary EUS-GE might require fewer procedures and less discontinuation of chemotherapy to achieve a comparable result. ispartof: CANCERS vol:14 issue:22 ispartof: location:Switzerland status: published

The elaboration of multichromophoric system which can undergo a reversible transformation over more than two different states can be easily performed by the covalent assembly of several identical switching subunits around a central node. However, the selective addressability of each of them still represents a challenging task. This study reports on the elaboration of multichromophoric systems incorporating three identical indolino-oxazolidine (BOX) moieties as multimodal addressable units. Depending of the open/closed oxazolidine ring status of each of them, these systems can be interconverted between four different states in stepwise manner by using indifferently acid addition or electrochemical stimulation. More important, we have demonstrated by using a dissymmetric triarylamine node that the classical statistical BOX opening is broken then reaching a regioselective addressability. The switching of the three identical BOX units differentiated by their π conjugated junction to the central core follows a preferential order leading to the preponderant and successive formation of only four forms over the eight theoretically and equally expected. To provide limitations and outlooks for such strategy, their switching capacities have been rationalized by DFT calculations.