EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: Results from a nationwide multicenter retrospective study

BACKGROUND AND AIMS: Traditionally, palliative treatment of malignant gastric outlet obstruction (GOO) has been surgical. Nevertheless, it associates 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-SEMS 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 (January 2015-June 2020). Stent failure-free survival at 1, 3 and 6 months, technical and clinical success, adverse events and patient survival were evaluated in both groups and compared. RESULTS: 97 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. Adverse events rate did not differ between groups (10.3% vs 10.1%) though two events in the EUS-GE group required surgical management. Patients in the EUS-GE had improved stent patency when compared with those patients in the D-SEMS Group at 3 months (92.23% vs 80.6%,) adjusted HR: 0.37; p=0.033. CONCLUSIONS: EUS-GE seems to have improved patency outcomes when compared with D-SEMS for palliative treatment of malignant GOO. Prospective trials are needed to fully compare their efficacy and adverse event profile.