Endoscopic Ultrasound Guided Gastro-enterostomy for Malignant Gastric Outlet Obstruction: Impact of Clinical and Demographic Factors on Outcomes.

Abstract

Background and aims: Endoscopic ultrasound guided gastroenterostomy (EUS-GE) has emerged as an alternative to surgical gastrojejunostomy and endoluminal stenting for malignant gastric outlet obstruction (MGOO). Studies regarding factors associated with the EUS-GE outcomes are limited.

Methods: A retrospective observational study was conducted with consecutive patients who underwent EUS-GE for MGOO at our center from January 2016 to November 2023. Primary outcomes were technical success (Establishing EUS-GE) and clinical success (Low residue diet tolerance without re-intervention at 90-day follow-up). Secondary outcomes were adverse events (AEs), reinterventions and full regular diet tolerance.

Results: Technical success and clinical success rates were 92.70% (127/137) and 88.00%, respectively, with 42.86% of the patients tolerating a regular diet. Patients with peritoneal carcinomatosis had lower odds of technical success (OR: 0.19, 95% CI: 0.04-0.93). Obstruction at the level of stomach, compared to duodenum, had lower odds of clinical success (OR: 0.06, 95% CI: 0.006-0.56). AE and reintervention rates were 14.17% and 8.66%, respectively. NGT decompression prior to EUS-GE was associated with lower AE rates in multivariable analysis (OR: 0.32, 95% CI: 0.11-0.95). Prior gastrointestinal surgery was associated with reintervention in multivariable analysis (OR: 4.09; 95% CI: 1.02-16.45, p-value: 0.047).

Conclusion: EUS-GE has high technical and clinical success rates, with many patients tolerating regular diet. Routine NGT decompression should be considered to minimize AEs. MGOO at the level of stomach is associated with lower clinical success rates. Extra care should be taken while performing EUS-GE in patients with peritoneal carcinomatosis. Prior gastrointestinal surgery is a likely risk factor for reintervention.