Esophagus to Small Intestine
Endoscopy. 2022;54(11):1023–31
Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for malignant gastric outlet obstruction: An international, multicenter, propensity score-matched comparison
Background: Endoscopic duodenal stenting is the current standard treatment for malignant gastric outlet obstruction (GOO) in patients with limited life expectancy. However, duodenal stenting is prone to stent dysfunction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique with potentially superior stent patency. The authors compared clinical success, safety, and stent dysfunction of EUS-GE and duodenal stenting in patients with malignant GOO using propensity score matching.
Methods: This international, multicenter, retrospective study analyzed consecutive patients undergoing EUS-GE or duodenal stenting for GOO between 2015 and 2021 in 3 European centers. Primary outcomes were clinical success (GOO scoring system [GOOSS] ≥ 2) and stent dysfunction (GOOSS ≤ 1 after initial clinical success). A propensity score matching (1:1) analysis was performed using age, sex, underlying disease, disease stage, ascites, and peritoneal carcinomatosis as variables.
Results: 214 patients underwent EUS-GE (n = 107) or duodenal stenting (n = 107). After propensity score matching, 176 patients were matched and compared. Technical success rates for EUS-GE and duodenal stenting were 94% (95% confidence interval [CI]: 89–99%) versus 98% (95% CI: 95–100%), respectively (p = 0.44). Clinical success rates were 91% (95% CI: 85–97%) versus 75% (95% CI: 66–84%; p = 0.008). Stent dysfunction occurred in 1% (95% CI: 0–4%) versus 26% (95% CI: 15–37%) of patients (p < 0.001). Adverse event rate was 10% (95% CI: 4–17%) versus 21% (95% CI: 12–29%; p = 0.09).
Conclusion: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) had higher clinical success and lower stent dysfunction, with similar safety, compared with duodenal stenting, suggesting that EUS-GE may be preferred over duodenal stenting in patients with malignant gastric outlet obstruction.
DOI: 10.1055/a-1782-7568