Endoscopic ultrasonography-guided gastroenterostomy for malignant gastric outlet obstruction: Comparison between gastric and duodenal obstruction

Abstract

BACKGROUND AND STUDY AIMS: It is currently unclear whether obstruction location affects clinical and procedure outcomes after endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) in patients with malignant gastric outlet obstruction (GOO). Therefore, we compared clinical outcomes of EUS-GE for malignant GOO located in the stomach with obstruction located in the duodenum. PATIENTS AND METHODS: In this nationwide, multicenter, retrospective study, we included consecutive patients who underwent EUS-GE as palliative treatment for malignant GOO. Main outcomes were clinical success, serious adverse events (SAEs) recurrence of obstructive symptoms, and LAMS dysfunction. RESULTS: Between 2018 and 2023, 298 patients underwent EUS-GE. Clinical success was achieved in 73 of 82 patients with a gastric obstruction (94%) and in 174 of 216 patients with a duodenal obstruction (87%). No association was found between location of obstruction and clinical success (odds ratio [OR] 2.62, 95% confidence interval [CI] 0.91 to 7.52, P = 0.073) or SAEs (OR 0.26, 95% CI 0.06 to 1.20, P = 0.083). Recurrent obstructive symptoms occurred more frequently in patients with a gastric obstruction (hazard ratio 1.74, 95% CI 1.09 to 2.77, P = 0.020). LAMS dysfunction did not differ between the groups (7 patients [9%] with a gastric obstruction and 11 patients [5%] with a duodenal obstruction). CONCLUSIONS: In this study, EUS-GE in patients with a gastric obstruction had comparable technical and clinical efficacy and a similar safety profile to EUS-GE for duodenal obstruction. However, gastric obstruction was associated with recurrent symptoms of obstruction unrelated to LAMS dysfunction.