918 Endoscopic Ultrasound-Guided Gastroenterostomy vs. Enteral Stenting for Treatment of Gastric Outlet Obstruction: A Retrospective Review

Abstract

INTRODUCTION: Gastric outlet obstruction (GOO) is a potential complication of pancreatic or distal gastric malignancy. As many as 15-20% of patients with pancreatic adenocarcinoma have GOO as a presenting symptom. Benign etiologies of GOO include chronic pancreatitis, peptic ulcer disease and caustic ingestion. Enteral stenting (ES) can be done for the palliation of GOO but recently endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a novel technique. We conducted a retrospective study to compare the differences in efficacy and safety of EUS-GE and ES. METHODS: Patients who underwent EUS-GE or ES for benign or malignant GOO from September 2015 to December 2018 were included in the study. Our primary outcomes were technical success defined as successful deployment of the stent and clinical success defined as tolerating oral diet after the procedure. Secondary outcomes were adverse events and need for unplanned re-intervention. Statistical analysis was done using SAS 9.4. RESULTS: Out 428 charts reviewed, 60 patients met are our inclusion criteria. 8 patients underwent EUS-GE and 52 patients underwent ES. Pancreatic adenocarcinoma was the most common etiology of GOO (58%) followed by gastric adenocarcinoma (13%). Chronic pancreatitis was the most common benign etiology of GOO (8%) requiring intervention. Technical success was 100% in both the groups. There was no significant difference in the clinical success (87.5% in EUS-GE vs 90.4% ES; P = 1.00) and rate of adverse events (12.5% EUS-GE vs 3.8% ES; P = 0.35) between the two groups. One patient in EUS-GE group did not achieve clinical success and underwent surgical gastrojejunostomy 23 days later which was also not clinically successful. The need for reintervention in clinically successful patients was 17% in the ES group due to tumor in-growth as compared to 0% in EUS-GE. Median time for re-intervention in the ES group was 94 days, (IQR: 43, 112). Two patients in an ES group required EUS-GE for the palliation of recurrence of symptoms. CONCLUSION: There were no differences in the technical success, clinical success and rate of adverse events of EUS-GE and ES for the treatment of GOO. Recurrence of symptoms and need for re-intervention trended higher in ES group compared to EUS-GE. Large prospective comparative trials are needed to evaluate the safety and efficacy of EUS-GE and ES.