EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction.
Endoscopic enteral stenting (ES) in malignant gastric outlet obstruction (GOO) is limited by high rates of stent obstruction. EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers sustained patency without tumor ingrowth/overgrowth. The aim of this study is to compare EUS-GE with ES in terms of (1) symptom recurrence and need for re-intervention, (2) technical success (proper stent positioning as determined via endoscopy and fluoroscopy), (3) clinical success (ability to tolerate oral intake without vomiting), and (4) procedure-related adverse events (AEs).



Multicenter retrospective study of all consecutive patients who underwent either EUS-GE at four centers between 2013 and 2015 or ES at one center between 2008 and 2010.



A total of 82 patients (mean age 66-years ± 13.5 and 40.2% female) were identified: 30 in EUS-GE and 52 in ES. Technical and clinical success was not significantly different: 86.7% EUS-GE versus 94.2% ES (p = 0.2) and 83.3% EUS-GE versus 67.3% ES (p = 0.12), respectively. Symptom recurrence and need for re-intervention, however, was significantly lower in the EUS-GE group (4.0 vs. 28.6%, (p = 0.015). Post-procedure mean length of hospitalization was comparable at 11.3 days ± 6.6 for EUS-GE versus 9.5 days ± 8.3 for ES (p = 0.3). Rates and severity of AEs (as per the ASGE lexicon) were also similar (16.7 vs. 11.5%, p = 0.5). On multivariable analysis, ES was independently associated with need for re-intervention (OR 12.8, p = 0.027).



EUS-GE may be ideal for malignant GOO with comparable effectiveness and safety to ES while being associated with fewer symptom recurrence and requirements for re-intervention.
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Yen-I
0000-0001-5704-2226
YI
Chen
Division of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan. itoi@tokyo-med.ac.jp.
Takao
T
Itoi
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA.
Todd H
TH
Baron
Borland-Groover Clinic, Jacksonville, FL, USA.
Jose
J
Nieto
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Yamile
Y
Haito-Chavez
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA.
Ian S
IS
Grimm
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Amr
A
Ismail
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Saowanee
S
Ngamruengphong
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Majidah
M
Bukhari
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Gulara
G
Hajiyeva
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Ahmad S
AS
Alawad
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Vivek
V
Kumbhari
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Mouen A
MA
Khashab
D000328:Adult; D000368:Aged; D004067:Digestive System Neoplasms / Q000150:complications*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005763:Gastroenterostomy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
Endoscopic ultrasound; Endoscopy; Gastric outlet obstruction; Stents