EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: results from a nationwide multicenter retrospective study (with video)

Post written by Rubén Sánchez-Aldehuelo, MD, from the Unidad de Endoscopia, Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Fundación para la Investigación Biomédica del Hospital Universitario Ramón y Cajal (IRYCIS), Universidad de Alcalá, and Enrique Vázquez-Sequeiros, MD, PhD, from the Unidad de Endoscopia, Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá and the Unidad de Endoscopia, Servicio de Gastroenterología y Hepatología, Hospital Quirón Salud, Madrid, Spain.

We aimed to compare the technical and clinical success and the safety profile of 2 endoscopic techniques used for the treatment of malignant gastric outlet obstruction: placement of a duodenal self-expandable metal stent (D-SEMS) versus EUS-guided gastroenterostomy (EUS-GE).

Vazquez-Sequeiros_photo

Treatment of malignant gastric outlet obstruction in a minimally invasive fashion remains a challenge. Improvements in survival of gastric and pancreatic tumors in recent years make this issue more relevant.

Although standard endoscopic treatment with D-SEMSs is associated with good results, its long-term performance still has some room for improvement because of its elevated rate of stent malfunction. It has been hypothesized that EUS-GE that avoids traversing the tumor may theoretically provide longer durability. However, this point is yet to be proven.

The current study represents a large multicenter experience with D-SEMSs and EUS-GE. The message we should take from this study is that, even in the early stage of the learning curve for EUS-GE, this new EUS-guided approach has the same technical success and safety profile as the D-SEMS approach.

Initial clinical success appears to be similar for both techniques, but stent patency was longer in the EUS-GE group, and differences were significant at 3 months. Comparative studies focusing on stent patency and cost-effectiveness are warranted.

Nonetheless, EUS-GE to palliate malignant gastric outlet obstruction is a promising technique.

Sanchez-Aldehuelo_Vazquez-Sequeiros_figureKaplan-Meier survival curves regarding stent failure–free survival in the 2 groups. D-SEMS, Duodenal self-expandable metallic stent; EUS-GE, EUS-guided gastroenterostomy; HR, hazard ratio.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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