Endoscopic ultrasound-guided gastroenterostomy for the management of gastric outlet obstruction : a large comparative study with long-term follow-up

Veeravich Jaruvongvanich, Tala Mahmoud, Barham K. Abu Dayyeh, Vinay Chandrasekhara, Ryan Law, Andrew C. Storm, Michael J. Levy, Eric J. Vargas, Neil B. Marya, Donna Maria Abboud, Rabih Ghazi, Reem Matar, Babusai Rapaka, Navtej S. Buttar, Mark J. Truty, Maridi Aerts, Nouredin Messaoudi, Rastislav Kunda

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Abstract

Background and study aims Gastric outlet obstruction (GOO) is traditionally managed with surgical gastroenterostomy (surgical-GE) and enteral stenting (ES). Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is now a third option. Large studies assessing their relative risks and benefits with adequate follow-up are lacking. We conducted a comparative analysis of patients who underwent EUS-GE, ES, or surgical-GE for GOO. Patients and methods In this retrospective comparative cohort study, consecutive patients presenting with GOO who underwent EUS-GE, ES, or surgical-GE at two academic institutions were reviewed and independently cross-edited to ensure accurate reporting. The primary outcome was need for reintervention. Secondary outcomes were technical and clinical success, length of hospital stay (LOS), and adverse events (AEs). Results A total of 436 patients (232 EUS-GE, 131 ES, 73 surgical-GE) were included. The median duration of follow-up of the entire cohort was 185.5 days (interquartile range 55.25–454.25 days). The rate of reintervention in the EUS-GE group was lower than in the ES and surgical-GE groups (0.9 %, 12.2 %, and 13.7 %, P < 0.0001). Technical success was achieved in 98.3 %, 99.2 %, and 100 % (P = 0.58), and clinical success was achieved in 98.3 %, 91.6 %, and 90.4 % (P < 0.0001) in the EUS-GE, ES, and surgical-GE groups, respectively. The EUS-GE group had a shorter LOS (2 days vs. 3 days vs. 5 days, P < 0.0001) and a lower AE rate than the ES and surgical-GE groups (8.6 % vs. 38.9 % vs. 27.4 %, P < 0.0001). Conclusion This large cohort study demonstrates the safety and palliation durability of EUS-GE as an alternative strategy for GOO palliation in select patients.
Original languageEnglish
Pages (from-to)E60-E66
Number of pages7
JournalEndoscopy international open
Volume11
Issue number1
DOIs
Publication statusPublished - 13 Jan 2023

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