Endoscopic ultrasound-guided gastroenterostomy versus surgical gastrojejunostomy for the palliation of gastric outlet obstruction in patients with peritoneal carcinomatosis

Ali Abbas; Russell D. Dolan; Ahmad Najdat Bazarbashi; Christopher C. Thompson

doi:10.1055/a-1708-0037

Endoscopy, Table of Contents

Endoscopy 2022; 54(07): 671-679
DOI: 10.1055/a-1708-0037

Original article

Endoscopic ultrasound-guided gastroenterostomy versus surgical gastrojejunostomy for the palliation of gastric outlet obstruction in patients with peritoneal carcinomatosis

Authors

Ali Abbas

¹Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA

²Division of Digestive Diseases & Nutrition, University of South Florida, Tampa, Florida, USA
Russell D. Dolan

¹Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
Ahmad Najdat Bazarbashi

¹Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
Christopher C. Thompson

¹Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA

Abstract

Background Gastric outlet obstruction (GOO) with peritoneal carcinomatosis presents a technical challenge. Surgical gastrojejunostomy (SGJ) or enteral stenting have been the standard of care; however, endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a favorable alternative. Few data exist that compare these techniques in the setting of peritoneal carcinomatosis.

Methods This single-center retrospective cohort study included 25 EUS-GE and 27 SGJ consecutive patients. Baseline demographics, cancer diagnosis and stage, clinical and technical success, adverse events, and obstruction recurrence data were collected. The primary outcome was the technical success comparison; secondary outcome was the adverse event rate comparison. Rates were compared with standard statistical tests.

Results Mean age, obstruction location, and symptoms were similar between the groups. The EUS-GE group had more advanced disease (clinical stage 4, 100 % vs. 67 %; P = 0.006) and higher American Society of Anesthesiologists classification (class 3–4, 92 % vs. 50 %; P = 0.004). The technical success rate was 100 % in both groups (P > 0.99) and the adverse event rate was lower for EUS-GE (8 % vs. 41 %; P = 0.01). Clinical success was 88 % for EUS-GE and 85 % for SGJ (P > 0.99) and recurrent obstruction was lower with EUS-GE (28 % vs. 41 %; P = 0.13). The EUS-GE group had shorter procedure duration, length of stay, and time to chemotherapy resumption than the SGJ group.

Conclusions Although the EUS-GE group was older, with more comorbidity and advanced stages, the technical success rate was similar to SGJ and it had significantly fewer adverse events. EUS-GE is a safe and effective option for the management of malignant GOO with peritoneal carcinomatosis.

Full Text

References

References
1 van Hooft JE, Dijkgraaf MG, Timmer R. et al. Independent predictors of survival in patients with incurable malignant gastric outlet obstruction: a multicenter prospective observational study. Scand J Gastroenterol 2010; 45: 1217-1222
2 Cho YK, Kim SW, Hur WH. et al. Clinical outcomes of self-expandable metal stent and prognostic factors for stent patency in gastric outlet obstruction caused by gastric cancer. Dig Dis Sci 2010; 55: 668-674
3 Kim HJ, Park JY, Bang S. et al. Self-expandable metal stents for recurrent malignant obstruction after gastric surgery. Hepatogastroenterology 2009; 56: 914-917
4 Warshaw AL, Fernández-del Castillo C. Pancreatic carcinoma. NEJM 1992; 326: 455-465
5 Keränen I, Udd M, Lepistö A. et al. Outcome for self-expandable metal stents in malignant gastroduodenal obstruction: single-center experience with 104 patients. Surg Endosc 2010; 24: 891-896
6 Jeurnink SM, Steyerberg EW, van Hooft JE. et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71: 490-499
7 Perez-Miranda M, Tyberg A, Poletto D. et al. EUS-guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. J Clin Gastroenterol 2017; 51: 896-909
8 Bednarsch J, Czigany Z, Heise D. et al. Influence of peritoneal carcinomatosis on perioperative outcome in palliative gastric bypass for malignant gastric outlet obstruction - a retrospective cohort study. World J Surg Oncol 2020; 18: 25
9 Zheng B, Wang X, Ma B. et al. Endoscopic stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Dig Endosc 2012; 24: 71-78
10 Itoi T, Baron TH, Khashab MA. et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc 2017; 29: 495-502
11 Chen YI, Kunda R, Storm AC. et al. EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques. Gastrointest Endosc 2018; 87: 1215-1221
12 Ge PS, Young JY, Dong W. et al. EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction. Surg Endosc 2019; 33: 3404-3411
13 Kerdsirichairat T, Irani S, Yang J. et al. Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction. Endosc Int Open 2019; 7: E144-E150
14 Tyberg A, Perez-Miranda M, Sanchez-Ocaña R. et al. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 2016; 4: E276-E281
15 Iqbal U, Khara HS, Hu Y. et al. EUS-guided gastroenterostomy for the management of gastric outlet obstruction: A systematic review and meta-analysis. Endosc Ultrasound 2020; 9: 16-23
16 Antonelli G, Kovacevic B, Karstensen JG. et al. Endoscopic ultrasound-guided gastro-enteric anastomosis: A systematic review and meta-analysis. Dig Liver Dis 2020; 52: 1294-1301
17 Chen YI, Itoi T, Baron TH. et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 2017; 31: 2946-2952
18 Khashab MA, Bukhari M, Baron TH. et al. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open 2017; 5: E275-E281
19 Kastelijn JB, Moons LMG, Garcia-Alonso FJ. et al. Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction. Endosc Int Open 2020; 8: E1194-E1201
20 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
21 McCarty TR, Garg R, Thompson CC. et al. Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E1474-E1482
22 Mantzorou M, Koutelidakis A, Theocharis S. et al. Clinical value of nutritional status in cancer: what is its impact and how it affects disease progression and prognosis?. Nutr Cancer 2017; 69: 1151-1176
23 Paul Olson TJ, Pinkerton C, Brasel KJ. et al. Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg 2014; 149: 383-392
24 Sadeghi B, Arvieux C, Glehen O. et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000; 88: 358-363
25 Belghiti J, Langonnet F, Bourstyn E. et al. Surgical implications of malnutrition and immunodeficiency in patients with carcinoma of the oesophagus. Br J Surg 1983; 70: 339-341
26 Jang S, Stevens T, Lopez R. et al. Superiority of gastrojejunostomy over endoscopic stenting for palliation of malignant gastric outlet obstruction. Clin Gastroenterol Hepatol 2019; 17: 1295-1302
27 Adler DG. Should patients with malignant gastric outlet obstruction receive stents or surgery?. Clin Gastroenterol Hepatol 2019; 17: 1242-1244