EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction
EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO); however, data comparing EUS-GE to enteral stent placement are limited. We aimed to compare clinical outcomes between EUS-GE and enteral stent placement in the palliation of malignant GOO.
Retrospective analysis of a prospectively collected database on patients who underwent EUS-GE or enteral stent placement for palliation of malignant GOO from 2014 to 2017 was conducted. Primary outcome was the rate of stent failure requiring repeat intervention. Secondary outcomes included technical and clinical success, time to repeat intervention, length of hospital stay, and adverse events.
A total of 100 consecutive patients (mean age 65.9 ± 11.9 years, 44.0% female) were identified, of which 78 underwent enteral stent placement, and 22 underwent EUS-GE. Rate of stent failure requiring repeat intervention was higher in the enteral stent group than the EUS-GE group (32.0% vs. 8.3%, p = 0.021). Technical success was achieved in 100% in both groups. Higher initial clinical success was attained in the EUS-GE group than the enteral stent group (95.8% vs. 76.3%, p = 0.042). Mean length of hospital stay following stent placement was similar between groups (p = 0.821). The enteral stent group trended towards increased adverse events (40.2% vs. 20.8%, p = 0.098). Kaplan–Meier analysis showed decreased stent function in the enteral stent group (p = 0.013).
Compared to enteral stent placement, EUS-GE has a higher rate of initial clinical success and lower rate of stent failure requiring repeat intervention. EUS-GE may be offered for selected patients with malignant GOO in centers with extensive experience.
KeywordsGastroenterostomy Gastric outlet obstruction GOO MGOO Lumen-apposing metal stent LAMS Enteral stent SEMS Therapeutic endoscopic ultrasound Pancreatic cancer
Compliance with ethical standards
Phillip S. Ge: Boston Scientific (Consultant). Christopher C. Thompson: Boston Scientific (Consultant), Medtronic (Consultant), USGI Medical (Consultant, Advisory Board Member, Research Support), Olympus (Consultant, Research Support), Apollo Endosurgery (Consultant, Research Support), GI Windows (Ownership Interest), Aspire Bariatrics (Research Support), Fractyl (Consultant, Advisory Board Member), Spatz (Research Support), EndoTAGSS (Ownership Interest), GI Dynamics (Consultant). Joyce Y. Young and William Dong have no conflicts of interest or financial ties to disclose.