EUS-Guided Gastroenterostomy in Malignant Gastric Outlet Obstruction: A Comparative Study between First- and Second-Line Approaches after Enteral Stent Placement

Enrique Perez-Cuadrado-Robles; Hadrien Alric; Ali Aidibi; Michiel Bronswijk; Giuseppe Vanella; Claire Gallois; Hedi Benosman; Emilia Ragot; Claire Rives-Lange; Gabriel Rahmi; Christophe Cellier

doi:10.3390/cancers14225516

EUS-Guided Gastroenterostomy in Malignant Gastric Outlet Obstruction: A Comparative Study between First- and Second-Line Approaches after Enteral Stent Placement

Cancers (Basel). 2022 Nov 10;14(22):5516. doi: 10.3390/cancers14225516.

Authors

Enrique Perez-Cuadrado-Robles^{1

2}, Hadrien Alric^{1

2}, Ali Aidibi¹, Michiel Bronswijk^{3

4}, Giuseppe Vanella⁵, Claire Gallois^{2

6}, Hedi Benosman¹, Emilia Ragot⁷, Claire Rives-Lange^{2

8}, Gabriel Rahmi^{1

2}, Christophe Cellier^{1

2}

Affiliations

¹ Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France.
² Faculty of Medicine, University of Paris-Cité, 75006 Paris, France.
³ Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, 3000 Leuven, Belgium.
⁴ Department of Gastroenterology and Hepatology, Imelda Hospital Bonheiden, 2820 Bonheiden, Belgium.
⁵ Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
⁶ Department of Oncology, Georges-Pompidou European Hospital, 75015 Paris, France.
⁷ Department of Surgery, Georges-Pompidou European Hospital, 75015 Paris, France.
⁸ Department of Nutrition, Georges-Pompidou European Hospital, 75015 Paris, France.

Abstract

Introduction: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly used in the setting of malignant gastric outlet obstruction (GOO). However, little is known about the role of primary EUS-GE. The aim of the present study is to compare the outcomes of EUS-GE by using the freehand technique as a first- and second-line approach after enteral stenting (ES).

Methods: This is an observational single-center study using a prospectively collected database. All consecutive patients who underwent an EUS-GE using the freehand technique due to malignant GOO were included. Patients with previous gastric surgery, a wire-guided EUS-GE technique, or those presenting without GOO were excluded. The primary outcome was the clinical success, defined as a solid oral intake at 1 week after the procedure (GOO Score, GOOSS ≥ 2). The secondary outcomes were technical success and adverse event (AE) rates. The impact on nutritional parameters was also assessed.

Results: Forty-five patients underwent an EUS-GE for all indications. Finally, 28 patients (mean age: 63 ± 17.2 years, 57.1% male) with (n = 13, 46.4%) and without (n = 15, 53.6%) a previous ES were included. The technical success was achieved in 25 cases (89.3%), with no differences between the two groups (92.3% vs. 86.7%, p = 1). The median limb diameter and procedure time were 27 mm (range:15-48) and 37 min. Overall, clinical success was achieved in 22 cases (88%), with three failures due to AEs (n = 2) or peritoneal carcinomatosis (n = 1). The diet progression was quicker in patients with a previous ES (GOOSS at 48 h, 2 vs. 1, p = 0.023), but the GOOSS at 1 week (p = 0.299), albumin gain (p = 0.366), and BMI gain (0.257) were comparable in the two groups. The AE rate was 7.1%.

Conclusions: EUS-GE achieves a high technical and clinical success in patients with GOO regardless of the presence of a previous ES. Patients with previous ES may have a quicker progression of their diet, but the GOOSS and nutritional status in the long term at 1 week or 1 month are comparable. Primary EUS-GE might require fewer procedures and less discontinuation of chemotherapy to achieve a comparable result.

Keywords: LAMS; endoscopic ultrasound; gastric outlet obstruction; pancreatic cancer.

Grants and funding

This research received no external funding.