PMID- 35870508 OWN - NLM STAT- MEDLINE DCOM- 20221122 LR - 20230524 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 96 IP - 6 DP - 2022 Dec TI - EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: results from a nationwide multicenter retrospective study (with video). PG - 1012-1020.e3 LID - S0016-5107(22)01835-1 [pii] LID - 10.1016/j.gie.2022.07.018 [doi] AB - BACKGROUND AND AIMS: Traditionally, palliative treatment of malignant gastric outlet obstruction (GOO) has been surgical, but surgical treatment carries significant morbidity and mortality rates. Endoscopic placement of a duodenal self-expandable metal stent (D-SEMS) has been proven to be successful for this indication in the short term. However, D-SEMSs are likely to malfunction over time. EUS-guided gastroenterostomy (EUS-GE) may help overcome these limitations. We aimed to evaluate stent failure-free survival at 3 months. METHODS: A nationwide multicenter, observational study of D-SEMS and EUS-GE procedures for patients with malignant GOO was conducted at 7 academic centers from January 2015 to June 2020. Stent failure-free survival at 1, 3, and 6 months; technical and clinical success; adverse events (AEs); and patient survival were evaluated in both groups and compared. RESULTS: Ninety-seven patients were included in the D-SEMS group and 79 in the EUS-GE group. Pancreatic cancer was the main underlying malignancy in 53.4%. No statistically significant differences regarding technical (92.8% vs 93.7%) or clinical success (83.5% vs 92.4%) were found. AE rates did not differ between groups (10.3% vs 10.1%), although 2 events in the EUS-GE group required surgical management. Patients in the EUS-GE group had improved stent patency when compared with those patients in the D-SEMS group at 3 months (92.23% vs 80.6%; adjusted hazard ratio, .37; P = .033). CONCLUSIONS: EUS-GE seems to have improved patency outcomes when compared with D-SEMS placement for palliative treatment of malignant GOO. Prospective trials are needed to fully compare their efficacy and AE profile. CI - Published by Elsevier Inc. FAU - Sanchez-Aldehuelo, Ruben AU - Sanchez-Aldehuelo R AD - Unidad de Endoscopia. Servicio de Gastroenterologia y Hepatologia, Hospital Universitario Ramon y Cajal, Fundacion para la Investigacion Biomedica del Hospital Universitario Ramon y Cajal (IRYCIS), Universidad de Alcala, Madrid, Spain. FAU - Subtil Inigo, Jose Carlos AU - Subtil Inigo JC AD - Unidad de Endoscopia, Servicio de Digestivo, Clinica Universidad de Navarra, Pamplona, Spain. FAU - Martinez Moreno, Belen AU - Martinez Moreno B AD - Unidad de Endoscopia, ISABIAL, Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, Spain. FAU - Gornals, Joan AU - Gornals J AD - Unidad de Endoscopia, Servicio de Aparato Digestivo, Hospital Universitario de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain. FAU - Guarner-Argente, Carlos AU - Guarner-Argente C AD - Unidad de Endoscopia, Servicio de Gastroenterologia y Hepatologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. FAU - Repiso Ortega, Alejandro AU - Repiso Ortega A AD - Unidad de Endoscopia, Servicio de Gastroenterologia y Hepatologia, Complejo Hospitalario de Toledo, Toledo, Spain. FAU - Peralta Herce, Sandra AU - Peralta Herce S AD - Unidad de Endoscopia, Servicio de Digestivo, Clinica Universidad de Navarra, Pamplona, Spain. FAU - Aparicio, Jose Ramon AU - Aparicio JR AD - Unidad de Endoscopia, ISABIAL, Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, Spain. FAU - Rodriguez de Santiago, Enrique AU - Rodriguez de Santiago E AD - Unidad de Endoscopia. Servicio de Gastroenterologia y Hepatologia, Hospital Universitario Ramon y Cajal, Fundacion para la Investigacion Biomedica del Hospital Universitario Ramon y Cajal (IRYCIS), Universidad de Alcala, Madrid, Spain. FAU - Bazaga, Sergio AU - Bazaga S AD - Unidad de Endoscopia, Servicio de Aparato Digestivo, Hospital Universitario de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain. FAU - Juzgado, Diego AU - Juzgado D AD - Unidad de Endoscopia, Servicio de Gastroenterologia y Hepatologia, Hospital Quiron Salud, Madrid, Spain. FAU - Gonzalez-Panizo, Fernando AU - Gonzalez-Panizo F AD - Unidad de Endoscopia, Servicio de Gastroenterologia y Hepatologia, Hospital Quiron Salud, Madrid, Spain. FAU - Albillos, Agustin AU - Albillos A AD - Unidad de Endoscopia. Servicio de Gastroenterologia y Hepatologia, Hospital Universitario Ramon y Cajal, Fundacion para la Investigacion Biomedica del Hospital Universitario Ramon y Cajal (IRYCIS), Universidad de Alcala, Madrid, Spain. FAU - Vazquez-Sequeiros, Enrique AU - Vazquez-Sequeiros E AD - Unidad de Endoscopia. Servicio de Gastroenterologia y Hepatologia, Hospital Universitario Ramon y Cajal, Fundacion para la Investigacion Biomedica del Hospital Universitario Ramon y Cajal (IRYCIS), Universidad de Alcala, Madrid, Spain; Unidad de Endoscopia, Servicio de Gastroenterologia y Hepatologia, Hospital Quiron Salud, Madrid, Spain. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Video-Audio Media DEP - 20220721 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 SB - IM CIN - Gastrointest Endosc. 2023 May;97(5):998. PMID: 37076205 MH - Humans MH - Retrospective Studies MH - Prospective Studies MH - *Gastric Outlet Obstruction/etiology/surgery MH - Gastroenterostomy/methods MH - *Self Expandable Metallic Stents MH - *Pancreatic Neoplasms/surgery MH - Stents EDAT- 2022/07/24 06:00 MHDA- 2022/11/23 06:00 CRDT- 2022/07/23 19:23 PHST- 2021/12/23 00:00 [received] PHST- 2022/06/29 00:00 [revised] PHST- 2022/07/08 00:00 [accepted] PHST- 2022/07/24 06:00 [pubmed] PHST- 2022/11/23 06:00 [medline] PHST- 2022/07/23 19:23 [entrez] AID - S0016-5107(22)01835-1 [pii] AID - 10.1016/j.gie.2022.07.018 [doi] PST - ppublish SO - Gastrointest Endosc. 2022 Dec;96(6):1012-1020.e3. doi: 10.1016/j.gie.2022.07.018. Epub 2022 Jul 21.