Background and Aims
Traditionally, palliative treatment of malignant gastric outlet obstruction (GOO)
has been surgical, but surgical treatment carries significant morbidity and mortality
rates. Endoscopic placement of a duodenal self-expandable metal stent (D-SEMS) has
been proven to be successful for this indication in the short term. However, D-SEMSs
are likely to malfunction over time. EUS-guided gastroenterostomy (EUS-GE) may help
overcome these limitations. We aimed to evaluate stent failure–free survival at 3
months.
Methods
A nationwide multicenter, observational study of D-SEMS and EUS-GE procedures for
patients with malignant GOO was conducted at 7 academic centers from January 2015
to June 2020. Stent failure–free survival at 1, 3, and 6 months; technical and clinical
success; adverse events (AEs); and patient survival were evaluated in both groups
and compared.
Results
Ninety-seven patients were included in the D-SEMS group and 79 in the EUS-GE group.
Pancreatic cancer was the main underlying malignancy in 53.4%. No statistically significant
differences regarding technical (92.8% vs 93.7%) or clinical success (83.5% vs 92.4%)
were found. AE rates did not differ between groups (10.3% vs 10.1%), although 2 events
in the EUS-GE group required surgical management. Patients in the EUS-GE group had
improved stent patency when compared with those patients in the D-SEMS group at 3
months (92.23% vs 80.6%; adjusted hazard ratio, .37; P = .033).
Conclusions
EUS-GE seems to have improved patency outcomes when compared with D-SEMS placement
for palliative treatment of malignant GOO. Prospective trials are needed to fully
compare their efficacy and AE profile.
Abbreviations:
AE (adverse event), CI (confidence interval), D-SEMS (duodenal self-expandable metallic stent), EUS-GE (EUS-guided gastroenterostomy), GOO (gastric outlet obstruction), LAMS (lumen-apposing metal stent)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 20, 2022
Accepted:
July 8,
2022
Received:
December 23,
2021
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: J. Gornals, C. Guarner-Argente, J. R. Aparicio: Consultant for Boston Scientific. E. Rodríguez de Santiago: Speaker for Olympus. E. Vázquez-Sequeiros: Consultant for Boston Scientific; speaker for Olympus and Ella-Biomed; A. Abillos: Consultant for Olympus. All other authors disclosed no financial relationships.
See CME section, p. 1071.
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© 2022 by the American Society for Gastrointestinal Endoscopy
