Post written by Manuel Pérez-Miranda, MD, PhD, from the Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.

Our study focuses on the short-term impact of EUS-guided gastroenterostomy (EUS-GE) on quality of life (QoL) in patients with malignant gastric outlet obstruction (GOO). Available EUS-GE case series rely on the achievement of a full diet or reintervention rates as the only means to assess the procedure’s clinical success.

Unfortunately, achieving a full diet does not improve QoL per se. Both enteral stents and surgical gastrojejunostomy allow patients to achieve a full diet. Although enteral stents achieve a short-term improvement in QoL, studies assessing the impact of surgical gastroenterostomy have failed to demonstrate a positive effect on QoL.

We prospectively assessed 64 consecutive patients with unresectable malignant GOO who underwent a technically successful EUS-GE between August 2019 and May 2021. Regardless of local follow-up, all patients underwent centralized follow-up by phone calls by an experienced research nurse at inclusion and 1, 7, and 30 days after EUS-GE. Participants completed the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 at baseline and 1 month after the procedure.

Thirty-three (51.6%) were men, the median age was 77.3 years (interquartile range, 65.5-86.5), and the most common diagnoses were pancreatic (35.9%) and gastric (31.3%) adenocarcinoma. Thirty-seven patients (57.9%) presented a 2/3 baseline Eastern Cooperative Oncology Group performance status score. Oral intake was restarted within 48 hours in 61 patients (95.3%), and the median postprocedure hospital stay was 3.5 days (interquartile range, 2-5). The 1-month survival rate was 84.4%.

Among patients completing the 30-day visit, 83.3% were on a soft/normal diet. A clinically significant increase of 21.6 points (95% confidence interval, 11.5-31.7) in the global health status scale was documented, with significant improvements in nausea and vomiting, pain, constipation, and appetite loss.

A global health improvement was observed regardless of the baseline performance score or disease extension. Interestingly, patients tolerating a full diet and those achieving only a soft diet presented similar improvements in their QoL. Long-term effects in QoL remain unknown, but with a median survival of roughly 3 months in malignant GOO, early improvement is of paramount importance.

We consider our findings strongly support including QoL as a primary endpoint in clinical trials assessing treatment alternatives for malignant GOO.

Individual progression of subjects completing both assessments. A threshold of ±10 points from baseline was used to define improvement or deterioration.

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