A National Perspective on Palliative Interventions for Malignant Gastric Outlet Obstruction

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BackgroundApproximately 15-20% of patients with duodenal or periampullary malignancies develop GOO. While small, randomized trials have reported more rapid recovery and shorter hospital stay with ES, limited studies have evaluated outcomes on a national level. The present study characterized short-term clinical and financial outcomes associated with gastrojejunostomy (GJ) versus endoscopic stenting (ES) in malignant gastric outlet obstruction (GOO). MethodsAdults with malignant GOO treated with ES or GJ were identified in the 2016-2020 Nationwide Readmissions Database. Entropy balancing was used to balance covariates between groups, and multivariable regression was used to evaluate the association between GJ or ES and in-hospital mortality, total parenteral nutrition (TPN) use, complications, length of stay (LOS), costs, and 90-day readmission. ResultsOf 8,186 GOO patients, 68.4% underwent ES and 31.6% GJ. The cohorts were similar in age, sex, and comorbidities, while GJ patients were more commonly frail. After risk adjustment, mortality, composite complications, and 90-day readmission were comparable between GJ and ES. GJ was associated with greater odds of blood transfusion (AOR 1.74 [95% CI [1.37-2.21]) and postoperative TPN use (AOR 3.76 [95% CI 2.64-5.35]). Furthermore, GJ patients experienced a significant increment of +$15,800 in costs and +6.9-day in LOS. On subgroup analysis of patients with metastatic disease, mortality, complications, and readmission remained comparable between palliation strategies. ConclusionsES appears to yield comparable short-term morbidity and mortality relative to GJ with significant cost reduction. Increasing access to endoscopic technology and regionalizing care to high-volume centers may help improve outcomes for patients with malignant GOO.