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).

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.

Kaplan-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.

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