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Prospective multicenter assessment of the impact of EUS-guided gastroenterostomy on patient quality of life in unresectable malignant gastric outlet obstruction

Published:February 17, 2023DOI:https://doi.org/10.1016/j.gie.2023.02.015
Prospective multicenter assessment of the impact of EUS-guided gastroenterostomy on patient quality of life in unresectable malignant gastric outlet obstruction
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      Abstract

      Background and aims

      Endoscopic ultrasound guided gastroenterostomy (EUS-GE) is increasingly used for malignant gastric outlet obstruction (GOO) in inoperable patients. However, the impact of EUS-GE on patient quality of life (QoL) has not been evaluated prospectively.

      Methods

      Consecutive patients with unresectable malignant GOO who underwent EUS-GE between August 2019 and May 2021 at four Spanish centers were prospectively assessed using the European Organization for Research and Treatment of Cancer (EORTC) questionnaire EORTC-QLQ-C30 at baseline and 1 month after the procedure. Centralized follow-up via telephone calls was undertaken. Gastric Outlet Obstruction Scoring System (GOOSS) was used to assess oral intake, defining clinical success as a GOOSS≥2. Differences between baseline and 30 days QoL scores were assessed using a linear mixed model.

      Results

      Sixty-four patients were enrolled, 33 (51.6%) males, median age 77.3 (IQR: 65.5-86.5) years. The most common diagnoses were pancreatic (35.9%) and gastric (31.3%) adenocarcinoma. Thirty-seven (57.9%) patients presented a 2/3 baseline ECOG performance status score. Oral intake was restarted within 48 hours in 61 (95.3%) patients and the median post-procedure hospital stay was 3.5 (IQR: 2-5) days. The 30-day clinical success rate was 83.3%. A clinically significant increase of 21.6 (95% CI: 11.5-31.7) points in the global health status scale was documented, with significant improvements in nausea/vomiting, pain, constipation and appetite loss.

      Conclusions

      EUS-GE has proven to relieve GOO symptoms in patients with unresectable malignancy, allowing rapid oral intake and hospital discharge. It also provides a clinically relevant increase in QoL scores at 30 days from baseline.

      Keywords

      List of acronyms employed:

      ECOG (Eastern Cooperative Oncology Group), EORTC (European Organization for Research and Treatment of Cancer), EUS (Endoscopic ultrasound), EUS-GE (Endoscopic ultrasound guided gastroenterostomy), GOO (gastric outlet obstruction), GOOSS (Gastric Outlet Obstruction Scoring System), INR (International normalized ratio), LAMS (Lumen-apposing metal stent), OR (Odds ratio), PEC (parallel enteral catheter), PS (performance status), REDCap (Research Electronic Data Capture tool), QoL (quality of life)
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      Article info

      Publication history

      Accepted: February 13, 2023
      Received in revised form: December 30, 2022
      Received: September 29, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Guarantor of the article: Dr. Manuel Perez-Miranda Head of Gastroenterology Department Hospital Universitario Rio Hortega, Valladolid, Spain

      Potential competing interests: Dr. Manuel Perez-Miranda is a consultant for Boston Scientific, Olympus, Medtronic, and M.I.Tech.

      Author contributions

      FJGA: study concept and design; analysis and interpretation of data; drafting of the manuscript; approval of the final version of the manuscript.

      CC: study concept and design; drafting of the manuscript; approval of the final version of the manuscript.

      JCS: acquisition of data; critical revision of the manuscript for important intellectual content; approval of the final version of the manuscript

      JRA: acquisition of data; critical revision of the manuscript for important intellectual content; approval of the final version of the manuscript

      VBB: acquisition of data; administrative, technical, or material support; approval of the final version of the manuscript

      BMM: acquisition of data; administrative, technical, or material support; approval of the final version of the manuscript

      JJV: acquisition of data; critical revision of the manuscript for important intellectual content; approval of the final version of the manuscript

      VMA: acquisition of data; administrative, technical, or material support; approval of the final version of the manuscript

      LSD: : acquisition of data; administrative, technical, or material support; approval of the final version of the manuscript

      CdlSH: acquisition of data; critical revision of the manuscript for important intellectual content; approval of the final version of the manuscript

      MPM: study concept and design; analysis and interpretation of data; drafting of the manuscript; approval of the final version of the manuscript

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.02.015

      Copyright

      © 2023 by the American Society for Gastrointestinal Endoscopy

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