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
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical review of EUS-guided gastroenterostomy (EUS-GE).J Clin Gastroenterol. 2020; 54: 1-7
- EUS-guided transluminal interventions.Gastroenterology. 2018; 154: 1911-1924
- ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction.Gastrointest Endosc. 2021; 93: 309-322
- EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction.Surg Endosc. 2017; 31: 2946-2952
- Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal.J Gastrointest Surg. 2006; 10: 286-291
- Palliative surgical bypass for pancreatic and peri-ampullary cancers.J Gastrointest Cancer. 2007; 38: 102-107
- A systematic review of methods to palliate malignant gastric outlet obstruction.Surg Endosc. 2010; 24: 290-297
- Malignant gastric outlet obstruction: Which is the best therapeutic option?.World J Gastroenterol. 2020; 26: 1847-1860
- Peroral insertion techniques of self-expanding metal stents for malignant gastric outlet and duodenal stenoses.Gastrointest Endosc. 1996; 44: 468-471
- Self-expandable metal stents for malignant gastric outlet obstruction: a pooled analysis of prospective literature.World J Gastroenterol. 2015; 21: 12468-12481
- Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review.BMC Gastroenterol. 2007; 7: 18
- Palliation of malignant gastric outlet obstruction with self-expanding metal stents.Endoscopy. 1996; 28: 225-228
- Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness.Endoscopy. 2004; 36: 543-550
- Outcomes of duodenal stenting: experience in a French tertiary center with 220 cases.Dig Liver Dis. 2020; 52: 51-56
- Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study.Endoscopy. 2012; 44: 499-503
- EUS-guided gastroenterostomy: the first U.S. clinical experience (with video).Gastrointest Endosc. 2015; 82: 932-938
- Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience.Endosc Int Open. 2016; 04: E276-E281
- Palliation of malignant gastric outlet obstruction.Surg Endosc. 2020; 33: 3404-3411
- EUS-guided gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis.Endosc Ultrasound. 2020; 9: 16-23
- Laparoscopic versus EUS-guided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score-matched comparison (with video).Gastrointest Endosc. 2021; 94: 526-536
- Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017.Dig Endosc. 2017; 29: 495-502
- A lexicon for endoscopic adverse events: report of an ASGE workshop.Gastrointest Endosc. 2010; 71: 446-454
- Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial.Gastrointest Endosc. 2010; 71: 490-499
- Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction.Surg Endosc. 2013; 27: 2068-2075
- Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction.Cochrane Database Syst Rev. 2018; 30 (CD012506)
- EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction.Surg Endosc. 2019; 33: 3404-3411
- Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients.Am J Gastroenterol. 2002; 97: 72-78
- Endoscopic gastroenterostomy: techniques and review.Curr Opin Gastroenterol. 2017; 33: 320-329
- Classification, outcomes, and management of misdeployed stents during EUS-guided gastroenterostomy.Gastrointest Endosc. 2022; 95: 80-89
- EUS-guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study.J Clin Gastroenterol. 2017; 51: 896-899
- International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction.Endosc Int Open. 2017; 05: E275-E281
- Endoscopic ultrasound-guided gastroenterostomy versus open surgical gastrojejunostomy: clinical outcomes and cost effectiveness analysis.Surg Endosc. 2021; 35: 7058-7067
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.
Identification
Copyright
© 2022 by the American Society for Gastrointestinal Endoscopy
