S1127 EUS-Guided Gastroenterostomy vs. Enteral Stenting for Palliation of Benign and Malignant Gastric Outlet Obstruction

Abstract

Introduction: Gastric outlet obstruction (GOO) can occur due to benign or malignant etiologies. Enteral stenting (ES) using self-expanding metal stents has been around for decades and remains a widely used technique in the palliation of GOO. With the advancement of interventional endoscopic ultrasound (EUS) techniques and the advent of lumen-apposing metal stents, EUS-guided gastroenterostomy (EUS-GE) has been adopted as a novel technique for treating symptomatic GOO in benign and malignant etiologies. We conducted a retrospective study to evaluate the outcomes of technical and clinical success and safety in patients with GOO undergoing EUS-GE versus ES. Methods: Patients who underwent EUS-GE or ES for GOO between September 2015 and December 2021 were included in the study. Primary outcomes included technical success defined as successful deployment of the stent and clinical success defined as relief of symptoms and tolerance of oral intake. Secondary outcomes were timing of unplanned re-intervention based on etiology and serious adverse events. Results: A total of 107 procedures among 103 patients met inclusion criteria, 63 (58.9%) underwent ES, and 44 (41.2%) underwent EUS-GE (Table). A higher percentage of malignant etiologies were in the enteral stenting group versus the EUS-GE group (88.9% vs 59.1%, p = 0.0003). Technical success among EUS-GE and ES patients was 100%. Clinical success was achieved by 90.5% of EUS-GE patients compared to 97.7% of ES patients, which was similar in both groups (p = 0.24). There was no significant difference in serious adverse events between EUS-GE and ES patients (3.2% vs 6.8%, p = 0.4). Thirteen ES patients required unplanned re-intervention compared to four EUS-GE patients (20.6% vs 9.1%) but the cumulative incidence functions were not significantly different (p = 0.11). The median time for reintervention in EUS-GE patients was 154 (50,425) days and 94 (43,112) days for ES patients. EUS-GE was associated with a significantly reduced need for unplanned reintervention in an adjusted model for etiology (benign or malignant) (HR: 0.264; 95% CI: 0.086, 0.813; p = 0.02). Conclusion: Technical success, clinical success, and rate of serious adverse events did not significantly differ among EUS-GE and ES patients. However, the rate of unplanned reintervention was significantly lower in the EUS-GE group when adjusted for the etiology of GOO, thus EUS-GE can be considered as a first line therapy for these patients. Table 1. - Summary of Patient Characteristics and Clinical Outcomes Procedures N = 107 Patients N = 103 Enteral Stenting N = 63 EUS-GE N = 44 P-value Age 0.19 Mean (SD) 69.5 (13.2) 65.9 (14.8) Range 38, 95 34, 91 Sex, n (%) 0.64 Male 33 (52.4%) 21 (47.7%) Female 30 (47.6%) 23 (52.3%) Etiology, n (%) 0.0003 Benign 7 (11.1%) 18 (40.9%) Malignant 56 (88.9%) 26 (59.1%) Technical success, n (%) N/A Yes 63 (100.0%) 44 (100.0%) Clinical success, n (%) 0.24 Yes 57 (90.5%) 42 (97.7%) Missing/Unknown 0 1 Serious Adverse event, n (%) 0.4 Yes 2 (3.2%) 3 (6.8%) Unplanned reintervention, n (%) 0.11 Yes 13 (20.6%) 4 (9.1%)