EUS-guided gastroenterostomy in malignant gastric outlet obstruction: a comparative study between first- and second-line approaches after enteral stent placement

Aims To compare the outcomes of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using the freehand technique as first- and second-line approach after enteral stenting (ES) in patients with gastric outlet obstruction (GOO).

Methods Observational single-center study. All consecutive patients who underwent a EUS-GE using the freehand technique due to malignant GOO were included. The primary outcome was the clinical success, defined as a solid oral intake at 1 week (GOOSS≥2). The secondary outcomes were technical success and adverse event (AE) rates.

Results Twenty-eight patients (mean age: 63±17.2 years, 57.1%male) with (n=13, 46.4%) and without (n=15, 53.6%) a previous ES were included. The technical success was 89.3%, with no differences between the two groups (92.3% vs. 86.7%, p=1). Overall, clinical success was achieved in 22 cases (88%), with three failures due to AEs (n=2) or peritoneal carcinomatosis (n=1). The diet progression was quicker in patients with a previous ES (GOOSS at 48h, 2 vs. 1, p=0.023), but the GOOSS at 1 week (p=0.299), albumin (p=0.366) and BMI gain (0.257) were comparable. The AE rate was 7.1%.

Conclusions EUS-GE achieves a high technical and clinical success in patients with GOO regardless of the presence of a previous ES. Patients with previous ES may have a quicker progression of their diet, but the GOOSS and nutritional status at long term are comparable. Primary EUS-GE might require fewer procedures and less discontinuation of chemotherapy to achieve a comparable result.

Conflicts of interest

Enrique Perez-Cuadrado-Robles is consultant of Boston Scientific

Publication History

Article published online:
14 April 2023