Laparoscopic Versus Eus-Guided Gastroenterostomy For Gastric Outlet Obstruction: An International Multicenter Propensity Score-Matched Comparison

Aims In the management of gastric outlet obstruction (GOO), EUS-guided gastroenterostomy (EUS-GE) seems safe and more effective than enteral stenting. However, comparisons to laparoscopic gastroenterostomy (L-GE) are scarce. Our aim was to perform a propensity score-matched comparison between EUS-GE and L-GE.

Methods An international, multicenter retrospective analysis was performed of consecutive EUS-GE and L-GE procedures in 3 academic centers (Jan-2015 to May-2020). A propensity score-matched design was used in order to minimize selection bias. Age, sex, underlying disease, disease stage, presence of ascites and/or peritoneal carcinomatosis were used as variables, with a standard maximum propensity score difference of 0.1. All EUS-GE were performed using the Wireless EUS-gastroenterostomy Simplified Technique (WEST).

Results Overall, 77 patients were treated with EUS-GE and 48 patients with L-GE. By means of propensity score-matching, 37 patients were allocated to both groups, resulting in 74 (1:1) matched patients.

Technical success was achieved in 35/37 EUS-GE-treated patients (94.6 %) vs. 100 % in the L-GE group (p=0.493). Clinical success, defined as eating without vomiting or GOO Scoring System ≥ 2, was achieved in 97.1 % and 89.2 % respectively (p=0.358). Median time to oral intake (1 (IQR 0.3-1.0) vs. 3 (IQR 1.0-5.0) days, p<0.001) and median hospital stay (4 (IQR 2-8) vs 8 (IQR 5.5-20) days, p<0.001) were significantly shorter in the EUS-GE group.

Overall adverse events (AEs) (2.7 % vs. 27.0 %, p=0.007) and severe AEs (0.0 % vs. 16.2 %, p=0.025) were identified more frequently in the L-GE group.

Tab. 1

	EUS-GE (n = 37)	L-GE (n = 37)	OR (95 % CI), P value
Technical success, n (%)	35 (94.6 %)	37 (100 %)	0.19 (0.01-4.08), 0.493
Clinical success, n (%)	34 (97.1 %)	33 (89.2 %)	4.12 (0.44-38.83), 0.358
Overall adverse events, n (%)	1 (2.7 %)	10 (27.0 %)	0.07 (0.01-0.62), 0.007
Severe adverse events, n(%)	0 (0.0 %)	6 (16.2 %)	0.07 (0.00-1.19), 0.025

Conclusions For patients with gastric outlet obstruction, EUS-GE and L-GE showed almost identical technical and clinical success. However, reduced time to oral intake, shorter median hospital stay and lower rate of adverse events prudentially suggest that EUS-GE should be the preferred approach. While awaiting high-quality prospective confirmation, these findings should guide gastroenterologists, oncologists and surgeons in considering EUS-GE for treating gastric outlet obstruction.

Citation: Bronswijk M, Vanella G, van Malenstein H et al. OP229 LAPAROSCOPIC VERSUS EUS-GUIDED GASTROENTEROSTOMY FOR GASTRIC OUTLET OBSTRUCTION: AN INTERNATIONAL MULTICENTER PROPENSITY SCORE-MATCHED COMPARISON. Endoscopy 2021; 53: S93.

Publication History

Article published online:
19 March 2021