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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
EUS-guided gastroenterostomy for management of malignant gastric outlet obstruction: a prospective cohort study with matched comparison with enteral stenting
Gastrointestinal Endoscopy, Volume 98, No. 3, Year 2023
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Description
Background and Aims: Retrospective studies on malignant gastric outlet obstruction (mGOO) highlighted several advantages of EUS-guided gastroenterostomy (EUS-GE) over enteral stenting (ES). However, no prospective evidence is available. The aim of this study was to report on clinical outcomes of EUS-GE in a prospective cohort study, with a subgroup comparison versus ES. Methods: All consecutive patients endoscopically treated for mGOO between December 2020 and December 2022 in a tertiary, academic center were enrolled in a prospective registry (Prospective Registry of Therapeutic Endoscopic Ultrasound [PROTECT]; NCT04813055) and followed up every 30 days to register efficacy/safety outcomes. EUS-GE and ES cohorts were matched according to baseline frailty and oncologic disease. Results: A total of 104 patients were treated for mGOO during the study; 70 (58.6% male subjects; median age, 64 [interquartile range, 58-73] years; 75.7% pancreatic cancer, 60.0% metastatic cancer) underwent EUS-GE via the wireless simplified technique. Technical success was 97.1% and clinical success was 97.1% after a median of 1.5 (interquartile range, 1-2) days. Adverse events occurred in 9 (12.9%) patients. After a median follow-up of 105 (49-187) days, symptom recurrence was 7.6%. In the matched comparison versus ES (28 patients per arm), EUS-GE–treated patients experienced higher and faster clinical success (100% vs 75.0%, P =.006), reduced recurrences (3.7% vs 33.3%, P =.02), and a trend toward shorter time to chemotherapy. Conclusions: In this first, prospective, single-center comparison, EUS-GE showed excellent efficacy in treating mGOO, with an acceptable safety profile and long-term patency, and several clinically significant advantages over ES. While awaiting randomized trials, these results might endorse EUS-GE as first-line strategy for mGOO, where adequate expertise is available. © 2023 American Society for Gastrointestinal Endoscopy
Authors & Co-Authors
Capurso, Gabriele
Unknown Affiliation
Casadei-Gardini, Andrea
Unknown Affiliation
Aldrighetti, Luca Antonio M.
Italy, Milan
Università Vita-salute San Raffaele
Falconi, Massimo
Unknown Affiliation
van der Merwe, Schalk Willem
Belgium, Leuven
Ku Leuven
Arcidiacono, Paolo Giorgio
Unknown Affiliation
Statistics
Citations: 7
Authors: 6
Affiliations: 4
Identifiers
Doi:
10.1016/j.gie.2023.04.2072
ISSN:
00165107
Research Areas
Cancer
Study Design
Cohort Study
Study Approach
Quantitative
Participants Gender
Male