Esophagus to Small Intestine
Gastrointest Endosc. 2023;98(1):28–35
Prospective multicenter assessment of the impact of EUS-guided gastroenterostomy on patient quality of life in unresectable malignant gastric outlet obstruction
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 4 Spanish centers were prospectively assessed using the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 at baseline and 1 month after the procedure. Centralized follow-up by telephone calls was undertaken. The Gastric Outlet Obstruction Scoring System (GOOSS) was used to assess oral intake, defining clinical success as a GOOSS ≥ 2. Differences between baseline and 30-day QoL scores were assessed using a linear mixed model.
Results: 64 patients were enrolled, 33 men (51.6%), with a median age of 77.3 years (interquartile range [IQR], 65.5–86.5 years). The most common diagnoses were pancreatic (35.9%) and gastric (31.3%) adenocarcinoma. 37 patients (57.9%) presented a 2/3 baseline Eastern Cooperative Oncology Group performance status score. Oral intake was restarted within 48 hours in 61 patients (95.3%), and the median postprocedure hospital stay was 3.5 days (IQR, 2–5 days). The 30-day clinical success rate was 83.3%. A clinically significant increase of 21.6 points (95% confidence interval: 11.5–31.7) in the global health status scale was documented, with significant improvements in nausea and vomiting, pain, constipation, and appetite loss.
Conclusions: Endoscopic ultrasound-guided gastroenterostomy relieves gastric outlet obstruction symptoms in patients with unresectable malignancy, allowing rapid oral intake and hospital discharge. It also provides a clinically relevant increase in quality-of-life scores at 30 days from baseline.