TY - JOUR
T1 - Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for malignant gastric outlet obstruction
T2 - An international, multicenter, propensity score-matched comparison
AU - van Wanrooij, Roy L. J.
AU - Vanella, Giuseppe
AU - Bronswijk, Michiel
AU - de Gooyer, Peter
AU - Laleman, Wim
AU - van Malenstein, Hannah
AU - Mandarino, Francesco Vito
AU - Dell'Anna, Giuseppe
AU - Fockens, Paul
AU - Arcidiacono, Paolo G.
AU - van der Merwe, Schalk W.
AU - Voermans, Rogier P.
N1 - Funding Information: RLJ van Wanrooij is a consultant for Boston Scientific. M Bronswijk is a consultant for Taewoong – Prion Medical. W Laleman is Co-Chair of the Boston Scientific Therapeutic Biliopancreatic Endoscopy group, and is a consultant for Boston Scientific and Cook. H van Malenstein is a consultant for Boston Scientific. P Fockens is a consultant for Olympus and Cook Medical. SW van der Merwe is Co-Chair of the Boston Scientific Therapeutic Biliopancreatic Endoscopy group and Chair of the Portal Hypertension group for Cook; he is also a consultant for Cook, Boston Scientific, and Pentax. RP Voermans is a consultant for Boston Scientific and has received research grants from Boston Scientific and Taewoong - Prion Medical. The remaining authors declare that they have no conflict of interest. Publisher Copyright: © 2022 Georg Thieme Verlag. All rights reserved.
PY - 2022/10/27
Y1 - 2022/10/27
N2 - Background Endoscopic duodenal stenting is the current standard treatment for malignant gastric outlet obstruction (GOO) in patients with limited life expectancy. However, duodenal stenting is prone to stent dysfunction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique with potentially superior stent patency. We compared clinical success, safety, and stent dysfunction of EUS-GE and duodenal stenting in patients with malignant GOO using propensity score matching. Methods This international, multicenter, retrospective study analyzed consecutive patients undergoing EUS-GE or duodenal stenting for GOO between 2015 and 2021 in three European centers. Primary outcomes were clinical success (GOO scoring system [GOOSS] ≥ 2) and stent dysfunction (GOOSS ≤ 1 after initial clinical success). A propensity score matching (1:1) analysis was performed using age, sex, underlying disease, disease stage, ascites, and peritoneal carcinomatosis as variables. Results 214 patients underwent EUS-GE (n = 107) or duodenal stenting (n = 107). After propensity score matching, 176 patients were matched and compared. Technical success rates for EUS-GE and duodenal stenting were 94 % (95 %CI 89 %-99 %) vs. 98 % (95 %CI 95 %-100 %), respectively (P = 0.44). Clinical success rates were 91 % (95 %CI 85 %-97 %) vs. 75 % (95 %CI 66 %-84 %; P = 0.008). Stent dysfunction occurred in 1 % (95 %CI 0-4 %) vs. 26 % (95 %CI 15 %-37 %) of patients (P < 0.001). Adverse event rate was 10 % (95 %CI 4 %-17 %) vs. 21 % (95 %CI 12 %-29 %; P = 0.09). Conclusion EUS-GE had higher clinical success and lower stent dysfunction, with similar safety, compared with duodenal stenting, suggesting that EUS-GE may be preferred over duodenal stenting in patients with malignant GOO.
AB - Background Endoscopic duodenal stenting is the current standard treatment for malignant gastric outlet obstruction (GOO) in patients with limited life expectancy. However, duodenal stenting is prone to stent dysfunction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique with potentially superior stent patency. We compared clinical success, safety, and stent dysfunction of EUS-GE and duodenal stenting in patients with malignant GOO using propensity score matching. Methods This international, multicenter, retrospective study analyzed consecutive patients undergoing EUS-GE or duodenal stenting for GOO between 2015 and 2021 in three European centers. Primary outcomes were clinical success (GOO scoring system [GOOSS] ≥ 2) and stent dysfunction (GOOSS ≤ 1 after initial clinical success). A propensity score matching (1:1) analysis was performed using age, sex, underlying disease, disease stage, ascites, and peritoneal carcinomatosis as variables. Results 214 patients underwent EUS-GE (n = 107) or duodenal stenting (n = 107). After propensity score matching, 176 patients were matched and compared. Technical success rates for EUS-GE and duodenal stenting were 94 % (95 %CI 89 %-99 %) vs. 98 % (95 %CI 95 %-100 %), respectively (P = 0.44). Clinical success rates were 91 % (95 %CI 85 %-97 %) vs. 75 % (95 %CI 66 %-84 %; P = 0.008). Stent dysfunction occurred in 1 % (95 %CI 0-4 %) vs. 26 % (95 %CI 15 %-37 %) of patients (P < 0.001). Adverse event rate was 10 % (95 %CI 4 %-17 %) vs. 21 % (95 %CI 12 %-29 %; P = 0.09). Conclusion EUS-GE had higher clinical success and lower stent dysfunction, with similar safety, compared with duodenal stenting, suggesting that EUS-GE may be preferred over duodenal stenting in patients with malignant GOO.
UR - http://www.scopus.com/inward/record.url?scp=85127683973&partnerID=8YFLogxK
U2 - https://doi.org/10.1055/a-1782-7568
DO - https://doi.org/10.1055/a-1782-7568
M3 - Article
C2 - 35325931
SN - 0013-726X
VL - 54
SP - 1023
EP - 1031
JO - Endoscopy
JF - Endoscopy
IS - 11
ER -