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 M Abboud; Rabih Ghazi; Reem Matar; Babusai Rapaka; Navtej Buttar; Mark J Truty; Maridi Aerts; Nouredin Messaoudi; Rastislav Kunda

doi:10.1055/a-1976-2279

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

Endosc Int Open. 2023 Jan 13;11(1):E60-E66. doi: 10.1055/a-1976-2279. eCollection 2023 Jan.

Authors

Veeravich Jaruvongvanich¹, Tala Mahmoud¹, Barham K Abu Dayyeh¹, Vinay Chandrasekhara¹, Ryan Law¹, Andrew C Storm¹, Michael J Levy¹, Eric J Vargas¹, Neil B Marya², Donna M Abboud¹, Rabih Ghazi¹, Reem Matar¹, Babusai Rapaka¹, Navtej Buttar¹, Mark J Truty³, Maridi Aerts⁴, Nouredin Messaoudi⁵, Rastislav Kunda⁶

Affiliations

¹ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States.
² Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts, United States.
³ Division of Surgery, Mayo Clinic, Rochester, Minnesota, United States.
⁴ Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
⁵ Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
⁶ Department of Surgery, Department of Gastroenterology-Hepatology, Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.

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.

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