title: International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction.
abstract: Background and study aimsEUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers long-lasting luminal patency without the risk of tumor ingrowth/overgrowth. This study compared the clinical success, technical success, adverse events (AEs), length of hospital stay (LOHS) and symptom recurrence in EUS-GE versus SGJ.MethodsThis was a multicenter international retrospective comparative study of EUS-GE and SGJ in patients with malignant gastric outlet obstruction (GOO) who underwent either EUS-GE or SGJ. EUS-GE was performed using lumen apposing metal stents.ResultsA total of 93 patients with malignant GOO treated with either EUS-GE (n = 30) or SGJ (n = 63) were identified. Peritoneal carcinomatosis was present in 13 (43 %) patients in the EUS-GE group and 7 (11 %) patients in the SGJ group (P< 0.001). Although the technical success rate was significantly higher in the SGJ group as compared to the EUS-GE group (100 % vs. 87 %,P= 0.009), the clinical success rate was not different (90 % vs. 87 %,P= 0.18, OR 0.8, 95 %CI 0.44 - 7.07). The rate of AEs was lower in the EUS-GE group, but the difference was not statistically significant (16 % vs 25 %,P= 0.3). The mean LOHS was similar in the EUS-GE group compared to SGJ (P= 0.35). The rate of recurrent GOO was not different between the two groups (3 % vs. 14 %,P= 0.08). Similarly, the mean time to reintervention was similar (88 days vs. 121 days,P= 0.83).ConclusionsEUS-GE is associated with equivalent efficacy and safety as compared to surgical GJ. This is the first comparative trial between both techniques and suggests EUS-GE as a non-inferior but less invasive alter to surgery.
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Majidah
authors.initials: M
authors.lastname: Bukhari
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Borland-Groover Clinic, Jacksonville, Florida, United States.
authors.forename: Jose
authors.initials: J
authors.lastname: Nieto
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Mohamad
authors.initials: M
authors.lastname: El Zein
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Yen-I
authors.initials: YI
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Yamile Haito
authors.initials: YH
authors.lastname: Chavez
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Alawad
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Division of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi