Does EUS-Guided Gastroenterostomy Improve Quality of Life in Patients With Malignant Gastric Outlet Obstruction?
Vanessa M. Shami, MD, FASGE, reviewing Garcia-Alonso FJ, et al. Gastrointest Endosc 2023 Feb 18.
Malignant gastric outlet obstruction (GOO) has a profound negative impact on quality of life (QoL). Options for palliation include surgical gastroenterostomy, enteral stent placement, and, most recently, endoscopic ultrasound-guided gastroenterostomy (EUS-GE). This multicenter prospective trial primarily aimed to study the impact of EUS-GE on patient QoL. Secondary outcomes were all-cause mortality, readmission, and adverse event rates.
Sixty-four patients with unresectable malignant GOO who underwent EUS-GE between August 2019 and May 2021 at 4 Spanish centers were prospectively enrolled. Thirty-three patients were male (51.6%), and the etiology of GOO in most patients was secondary to pancreatic (35.9%) or gastric (31.3%) cancer.
The European Organization for Research and Treatment of Cancer (EORTC) questionnaire EORTC-QLQ-C30 was used to assess patients at baseline and 1 month after the procedure. Patients received follow-up telephone calls at inclusion and 1, 7, and 30 days after EUS-GE. The Gastric Outlet Obstruction Scoring System (GOOSS) was used to evaluate oral intake, with clinical success defined as a GOOSS ≥2. A linear mixed model assessed differences between baseline and 30-day QoL scores.
Most patients (n=61, 95.3%) restarted oral intake within 48 hours, and the median postprocedure hospital stay was 3.5 days (interquartile range, 2-5). The 30-day clinical success rate was 83.3%. There was a clinically significant increase of 21.6 points (95% confidence interval, 11.5-31.7) in the global health status scale, with significant improvements in symptoms. Adverse events occurred in 10 patients (15.6%): 6 were self-limiting, 3 required endoscopic reintervention, and 1 patient died.
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Garcia-Alonso FJ, Chavarria C, Subtil JC, et al. Prospective multicenter assessment of the impact of EUS-guided gastroenterostomy on patient quality of life in unresectable malignant gastric outlet obstruction. Gastrointest Endosc 2023 Feb 18. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2023.02.015)