EUS-GUIDED GASTROJEJUNOSTOMY VERSUS DUODENAL STENTS FOR MALIGNANT GASTRIC OUTLET OBSTRUCTION: AN INTERNATIONAL MULTICENTER PROPENSITY SCORE MATCHED COMPARISON

Aims Duodenal self-expendable metal stents (SEMS) for malignant gastric outlet obstruction(GOO) are prone for recurrent GOO. EUS-guided gastrojejunostomy(EUS-GJ) is emerging as a novel technique which potentially leads to less recurrent GOO. Advantages over SEMS have been evaluated in retrospective studies with poor control for confounders. Our aim was to compare efficacy, safety and dysfunction rate of EUS-GJ and SEMS in patients with GOO using propensity-score matching.

Methods We conducted an international multicenter retrospective analysis of all consecutive patients undergoing either duodenal SEMS placement or EUS-GJ for a malignant GOO between 2015-2021 in 3 European centers. Patients with follow-up<30 days were excluded. Primary outcomes were clinical success (possibility to eat at least soft solids after the procedure (GOO scoring system (GOOSS)≥2) and stent dysfunction (recurrence of GOO(GOOSS≤1) after initial clinical success).A propensity score-matched(1:1) analysis was performed using age, sex, underlying disease, disease stage, ascites and peritoneal carcinomatosis as variables.

Results A total of 224 patients were identified receiving either EUS-GJ(107) or SEMS(107). After matching, 176 patients (88 per arm) were matched. Mean age was 66 years (SD±11.8), 58% had pancreatic cancer, 32% peritoneal metastasis and 35% ascites. No significant differences in baseline characteristics were detected. Primary outcome is summarised in [Table 1] and [Figure 1.] Overall adverse events(10.2vs.20.5%,p=0.093) did not differ.

Table 1

Efficacy	E US GJ (n=88)	Duodenal SEMS (n=88)	OR (95%-CI)	p value
Technical succes	83 (94.3%)	86 (97.7%)	0.39 (0.07 – 2.04)	0.444
Clinical success	80 (90.9%)	66 (75%)	3.33 (1.39 – 8.00)	0.008
Dysfunction (after clinical succes)	1 (1.3%)	17 (25.8%)	0.04 (0.01 – 0.28)	<0.001
Median time to dysfuction, days (IQR)	243	57 (27–169.5)		0.222​​​​

Fig. 1

Conclusions EUS-GJ resulted in higher initial clinical success and lower stent dysfunction rates with comparable safety in comparison with duodenal SEMS. These data suggest that EUS-GJ may be preferred over duodenal SEMS in patients with a malignant gastric outlet obstruction.

Publication History

Article published online:
14 April 2022