PMID- 37004816
OWN - NLM
STAT- MEDLINE
DCOM- 20230821
LR  - 20230830
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 98
IP  - 3
DP  - 2023 Sep
TI  - Benefits of EUS-guided gastroenterostomy over surgical gastrojejunostomy in the 
      palliation of malignant gastric outlet obstruction: a large multicenter 
      experience.
PG  - 348-359.e30
LID - S0016-5107(23)00362-0 [pii]
LID - 10.1016/j.gie.2023.03.022 [doi]
AB  - BACKGROUND AND AIMS: Palliation of malignant gastric outlet obstruction (mGOO) 
      allows resumption of peroral intake. Although surgical gastrojejunostomy (SGJ) 
      provides durable relief, it may be associated with a higher morbidity, interfere 
      with chemotherapy, and require an optimum nutritional status. EUS-guided 
      gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative. We 
      aimed to conduct the largest comparative series to date between EUS-GE and SGJ 
      for mGOO. METHODS: This multicenter retrospective study included consecutive 
      patients undergoing SGJ or EUS-GE at 6 centers. Primary outcomes included time to 
      resumption of oral intake, length of stay (LOS), and mortality. Secondary 
      outcomes included technical and clinical success, reintervention rates, adverse 
      events (AEs), and resumption of chemotherapy. RESULTS: A total of 310 patients 
      were included (EUS-GE, n = 187; SGJ, n = 123). EUS-GE exhibited significantly 
      lower time to resumption of oral intake (1.40 vs 4.06 days, P < .001), at lower 
      albumin levels (2.95 vs 3.33 g/dL, P < .001), and a shorter LOS (5.31 vs 8.54 
      days, P < .001) compared with SGJ; there was no difference in mortality (48.1% vs 
      50.4%, P = .78). Technical (97.9% and 100%) and clinical (94.1% vs 94.3%) success 
      was similar in the EUS-GE and SGJ groups, respectively. EUS-GE had lower rates of 
      AEs (13.4% vs 33.3%, P < .001) but higher reintervention rates (15.5% vs 1.63%, 
      P < .001). EUS-GE patients exhibited significantly lower interval time to 
      resumption of chemotherapy (16.6 vs 37.8 days, P < .001). Outcomes between the 
      EUS-GE and laparoscopic (n = 46) surgical approach showed that EUS-GE had shorter 
      interval time to initiation/resumption of oral intake (3.49 vs 1.46 days, P < 
      .001), decreased LOS (9 vs 5.31 days, P < .001), and a lower rate of AEs (11.9% 
      vs 17.9%, P = .003). CONCLUSIONS: This is the largest study to date showing that 
      EUS-GE can be performed among nutritionally deficient patients without affecting 
      the technical and clinical success compared with SGJ. EUS-GE is associated with 
      fewer AEs while allowing earlier resumption of diet and chemotherapy.
CI  - Copyright (c) 2023 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Canakis, Andrew
AU  - Canakis A
AD  - Division of Gastroenterology and Hepatology, University of Maryland Medical 
      Center, Baltimore, Maryland, USA.
FAU - Bomman, Shivanand
AU  - Bomman S
AD  - Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, 
      Seattle, Washington, USA.
FAU - Lee, David U
AU  - Lee DU
AD  - Division of Gastroenterology and Hepatology, University of Maryland Medical 
      Center, Baltimore, Maryland, USA.
FAU - Ross, Andrew
AU  - Ross A
AD  - Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, 
      Seattle, Washington, USA.
FAU - Larsen, Michael
AU  - Larsen M
AD  - Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, 
      Seattle, Washington, USA.
FAU - Krishnamoorthi, Rajesh
AU  - Krishnamoorthi R
AD  - Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, 
      Seattle, Washington, USA.
FAU - Alseidi, Adnan A
AU  - Alseidi AA
AD  - Department of Surgery.
FAU - Adam, Mohamed Abdelgadir
AU  - Adam MA
AD  - Department of Surgery.
FAU - Kouanda, Abdul
AU  - Kouanda A
AD  - Division of Gastroenterology and Hepatology, University of California, San 
      Francisco, San Francisco, California, USA.
FAU - Sharaiha, Reem Z
AU  - Sharaiha RZ
AD  - Division of Gastroenterology and Hepatology, Weill Medical College of Cornell 
      University, New York, New York, USA.
FAU - Mahadev, SriHari
AU  - Mahadev S
AD  - Division of Gastroenterology and Hepatology, Weill Medical College of Cornell 
      University, New York, New York, USA.
FAU - Dawod, Sanad
AU  - Dawod S
AD  - Division of Gastroenterology and Hepatology, Weill Medical College of Cornell 
      University, New York, New York, USA.
FAU - Sampath, Kartik
AU  - Sampath K
AD  - Division of Gastroenterology and Hepatology, Weill Medical College of Cornell 
      University, New York, New York, USA.
FAU - Arain, Mustafa A
AU  - Arain MA
AD  - Center for Interventional Endoscopy.
FAU - Farooq, Aimen
AU  - Farooq A
AD  - Center for Interventional Endoscopy.
FAU - Hasan, Muhammad K
AU  - Hasan MK
AD  - Center for Interventional Endoscopy.
FAU - Kadkhodayan, Kambiz
AU  - Kadkhodayan K
AD  - Center for Interventional Endoscopy.
FAU - de la Fuente, Sebastian G
AU  - de la Fuente SG
AD  - Department of Surgery, AdventHealth, Orlando, Florida, USA.
FAU - Benias, Petros C
AU  - Benias PC
AD  - Division of Gastroenterology, Lenox Hill Hospital, New York, New York, USA.
FAU - Trindade, Arvind J
AU  - Trindade AJ
AD  - Division of Gastroenterology, Long Island Jewish Medical Center, New Hyde Park, 
      New York, USA.
FAU - Ma, Michael
AU  - Ma M
AD  - Division of Gastroenterology, Lenox Hill Hospital, New York, New York, USA.
FAU - Gilman, Andrew J
AU  - Gilman AJ
AD  - Division of Gastroenterology and Hepatology, University of North Carolina at 
      Chapel Hill, Chapel Hill, North Carolina, USA.
FAU - Fan, Gregory H
AU  - Fan GH
AD  - Tufts Medical Center, Boston, Massachusetts, USA.
FAU - Baron, Todd H
AU  - Baron TH
AD  - Division of Gastroenterology and Hepatology, University of North Carolina at 
      Chapel Hill, Chapel Hill, North Carolina, USA.
FAU - Irani, Shayan S
AU  - Irani SS
AD  - Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, 
      Seattle, Washington, USA. Electronic address: shayan.irani@virginiamason.org.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20230331
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Humans
MH  - *Gastric Bypass
MH  - Retrospective Studies
MH  - Endosonography
MH  - Stents
MH  - Gastroenterostomy
MH  - *Gastric Outlet Obstruction/etiology/surgery
EDAT- 2023/04/03 06:00
MHDA- 2023/08/21 06:43
CRDT- 2023/04/02 19:23
PHST- 2023/01/14 00:00 [received]
PHST- 2023/03/12 00:00 [revised]
PHST- 2023/03/14 00:00 [accepted]
PHST- 2023/08/21 06:43 [medline]
PHST- 2023/04/03 06:00 [pubmed]
PHST- 2023/04/02 19:23 [entrez]
AID - S0016-5107(23)00362-0 [pii]
AID - 10.1016/j.gie.2023.03.022 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2023 Sep;98(3):348-359.e30. doi: 10.1016/j.gie.2023.03.022. 
      Epub 2023 Mar 31.