Benefits of EUS-Guided Gastroenterostomy Over Surgical Gastrojejunostomy in the Palliation of Malignant Gastric Outlet Obstruction: A Large Multicenter Experience.
Academic Article
Overview
abstract
BACKGROUND AND AIMS: Palliation of malignant gastric outlet obstruction (mGOO) allows resumption of peroral intake. Although surgical gastrojejunostomy (SGJ) provides durable relief; it may be associated with a higher morbidity, interfere with chemotherapy and require an optimum nutritional status. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative. We aimed to conduct the largest comparative series between EUS-GE and SGJ for mGOO. METHODS: Multicenter retrospective study of consecutive patients undergoing SGJ or EUS-GE at six centers. Primary outcomes included time to resumption of oral intake, length of stay (LOS) and mortality. Secondary outcomes included technical and clinical success, reintervention rates, adverse events (AEs) and resumption of chemotherapy. RESULTS: 310 patients were included (EUS-GE 187, SGJ 123). EUS-GE exhibited significantly lower time to resumption of oral intake (1.40 vs 4.06 days, p<0.001 at lower albumin levels (2.95 vs 3.33, p<0.001) and a shorter LOS (5.31 vs 8.54, p<0.001) compared to SGJ, with no difference in mortality (48.1% vs 50.4% p=0.78) Technical (97.9% and 100%) and clinical (94.1% vs 94.3%) success was similar in the EUS-GE and SGJ groups, respectively. EUS-GE had lower AEs (13.4% vs 33.3%, p<0.001), but higher reintervention rates (15.5% vs 1.63%, p<0.001). EUS-GE patients exhibited significantly lower interval time to resumption of chemotherapy (16.6 vs 37.8 days p<0.001). Outcomes between EUS-GE and laparoscopic (n=46) surgical approach showed that EUS-GE had shorter interval time to initiation/resumption of oral intake (3.49 vs 1.46, p<0.001), decreased LOS (9 vs 5.31, p<0.001), and a lower rate of adverse events (11.9% vs 17.9%, p= 0.003). CONCLUSION: This is the largest study showing EUS-GE can be performed among nutritionally deficient patients without impacting the technical and clinical success compared to SGJ. EUS-GE is associated with fewer AEs while allowing sooner resumption of diet and chemotherapy.
