Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for malignant gastric outlet obstruction: an international, multicenter, propensity score-matched comparison

Abstract

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. We 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 three 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 %CI 89 %–99 %) vs. 98 % (95 %CI 95 %–100 %), respectively (P = 0.44). Clinical success rates were 91 % (95 %CI 85 %–97 %) vs. 75 % (95 %CI 66 %–84 %; P = 0.008). Stent dysfunction occurred in 1 % (95 %CI 0–4 %) vs. 26 % (95 %CI 15 %–37 %) of patients (P < 0.001). Adverse event rate was 10 % (95 %CI 4 %–17 %) vs. 21 % (95 %CI 12 %–29 %; P = 0.09). Conclusion 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 GOO.

Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis

“…Although surgical gastrojejunostomy has shown better long‐term results, ES is still widely used for malignant GOO, 20 despite providing suboptimal relief from symptoms and a higher risk of recurrence. 8 EUS‐GE is increasingly being used as an alternative to both ES and surgical bypass, as it avoids the invasiveness of surgery and the risk of primary failure, recurrence, and need for re‐interventions following ES. 8 , 16 …”

“… 8 EUS‐GE is increasingly being used as an alternative to both ES and surgical bypass, as it avoids the invasiveness of surgery and the risk of primary failure, recurrence, and need for re‐interventions following ES. 8 , 16 …”

“…As a significantly higher GOO recurrence is expected in the ES group versus the EUS‐GE group independently from any combination, 8 a subgroup analysis was performed analysing only biliary events (biliary vs. no dysfunction), excluding all patients experiencing GOO recurrence.…”

“…As for GOO, growing evidence supports EUS‐guided gastroenterostomy (EUS‐GE) over enteral metal stents (ES) in terms of clinical success and symptoms recurrence. 6 , 7 , 8 …”

Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting: the retrospective story’s been told, now it’s time for a prospective one

“…In this issue of Endoscopy , the nicely conducted study by van Wanrooij et al compared the efficacy, safety, and stent dysfunction rates of EUS-GE vs. duodenal stenting in patients with malignant GOO using propensity score matching 8 . The study was conducted between 2015 and 2021 across three European centers with expertise in EUS-guided interventions.…”