Clinical Success Impacts Overall Survival in Patients Undergoing Palliation for Malignant Gastric Outlet Obstruction Using Enteral Stents or Endoscopic Ultrasound Guided Gastroenterostomy.

backgroundEUS-guided gastroenterostomy (EUS-GE) and enteral stents (ES) are minimally invasive options for managing malignant gastric outlet obstruction (mGOO). We aimed to compare EUS-GE with ES with respect to clinical success assessed objectively and overall survival.

methodsRetrospective review of patients > 18 years who underwent either ES or EUS-GE for palliation of mGOO between January 2021 and January 2024 was done. Primary outcomes were clinical success (defined as improvement of oral intake and tolerance of higher consistency diet compared to baseline by 2 points using GOOSS) and overall survival. Secondary outcomes were adverse events, reintervention rates, and reintervention-free survival.

resultsOne-hundred and seventy-two patients were included (112 ES group and 60 EUS-GE). The most common background malignancy was pancreatic cancer (30.2%), followed by gall-bladder cancer (26.2%). Technical success rates were similar (EUS-GE 95.08% and ES 99.09%; p = 0.123). Clinical success was achieved more often in those who underwent EUS-GE (94.7% vs. 77.5%, p = 0.004, OR 5.233). Overall survival (ES 112 days vs. EUS-GE 177 days, p = 0.787) was not statistically different in the two groups. Although reintervention was needed in ES more often (18.9% vs. 3.3%, p = 0.005, OR 5.392), reintervention-free survival (ES 93 days vs. EUS-GE 177 days, p = 0.581) did not differ. Overall survival was lower in those who did not achieve clinical success (clinical success-no, 49 days; yes, 134 days, p = 0.013).

conclusionEUS-GE could achieve better outcomes than ES in terms of the nature of oral intake feasible with lesser need for reintervention, with patients achieving clinical success surviving longer.