Comparison of Safety Profile, Clinical Success, and Re-intervention Rates in EUS-Guided Gastroenterostomy (EUS-GE) versus Enteral Self-Expanding Metal Stent (SEMS) in Patients with Malignant Gastric Outlet Obstruction

Introduction: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Data comparing outcomes of EUS-GE with enteral self-expanding metal stent (SEMS) in malignant GOO are limited.

Aim: To compare safety profile, clinical outcomes and re-intervention rates between EUS-GE and enteral SEMS in the palliation of malignant GOO.

Methods: Retrospective analysis of a prospectively collected database. EUS-GE or enteral SEMS placement for palliation of malignant GOO (December 2019–August 2023). Outcomes: technical and clinical success, adverse events (AE), length-of-hospital stay (LOS), and need for re-intervention.

Results: N = 50 included (n = 20-EUS-GE, n = 30-enteral SEMS). Mean age- EUS-GE: 62.4 years ± 4 and 62.4 years ± 11.8 for enteral SEMS; 64% males. Both groups were comparable in terms of clinical presentation (p = 0.405). Location of GOO- Proximal duodenum -75% of patients in EUS GE group, 66.7% in Enteral SEMS group (p = 0.529), antrum: 25% of patients in EUS GE group and 33.7% in enteral SEMS group. Etiology of GOO was comparable in both the groups (p = 0.981) with carcinoma head of pancreas as most common. Technical and clinical successes were achieved in 90% in EUS-GE and 100% in enteral SEMS group, respectively (p = 0.058, p = 0.155). Mean (LOS) for EUS-GE group was 4.8 days ± 2.9 and 3.5 days ± 3.0 for the enteral SEMS group (p = 0.133). Re- intervention none in EUS GE, two patients in enteral SEMS group (p = 0.16). The median survival (EUS-GE group: 5.4 ± 4.6 months, enteral SEMS group: 5.5 ± 4.2 months [p = 0.976]) ([Table 1]).

Conclusion: Both EUS-GE and enteral SEMS demonstrated comparable outcomes in—technical and clinical success, safety profile and re-intervention. Median survival <6 months could have impacted study outcomes and (outcomes of enteral SEMS were noninferior). Further studies in patients with long-term survival are required to demonstrate superiority of one modality over the other.

Table 1 Comparison of baseline characteristics and outcomes between EUS-GE and enteral SEMS

		EUS-GE	Enteral SEMS	p-Value
		n (%)	n (%)
Patients		20 (40)	30 (60)	–
Age in years (mean ± SD)		64.2 ± 14	64.2 ± 11.8	0.995
Gender	Male	10 (50)	22 (73.3)	0.138
	Female	10 (50)	8 (26.7)
Symptoms	Abdominal pain vomiting, jaundice	9 (45)	10 (33.3)	0.405
	Abdominal pain, vomiting	11 (5)	20 (66.7)
Etiology of GOO	Ca duodenum	3 (15)	4 (13)	0.981
	Ca gall bladder	1 (5)	2 (7)
	Ca head of pancreas	10 (50)	12 (40)
	Ca stomach	4 (20)	7 (23)
	Hilar cholangio Ca	1 (5)	3 (10)
	Metastasis	1 (5)	2 (7)
Location of GOO	Antrum	5 (25)	10 (33.3)	0.529
	Proximal duodenum	15 (75)	20 (66.7)
Technical success	Yes	18 (90)	30 (100)	0.16
	No	2 (10)	0 (0)
Clinical success	Yes	18 (90)	30 (100)	0.155
	No	2 (10)	0 (0)
Need for re-intervention	Yes	1 (5.9)	1 (3.6)	0.587
	No	17 (94.1)	28 (96.4)
Length of hospital stay (in days) (mean ± SD)		4.8 ± 2.9	3.5 ± 3.0	0.133
Median survival/follow-up time (in months) (mean ± SD)		5.4 ± 4.6	5.5 ± 4.2	0.976

Publication History

Article published online:
22 April 2024