What Is the Best Option for the Endoscopic Management of Malignant Gastric Outlet Obstruction?

What Is the Best Option for the Endoscopic Management of Malignant Gastric Outlet Obstruction?

Vanessa M. Shami, MD, FASGE, reviewing Sánchez-Aldehuelo R, et al. Gastrointest Endosc 2022 Jul 20.

Malignant gastric outlet obstruction (GOO) requires prompt surgical or endoscopic decompression. Surgery is associated with significant morbidity and mortality. Fortunately, with the evolution of endoscopic palliative techniques such as duodenal self-expandable metal stent (D-SEMS) placement and EUS-guided gastroenterostomy (EUS-GE), gastroenterologists have available alternatives to palliate these patients. This multicenter (7 academic centers) observational study compared and evaluated the technical and clinical success, adverse events, patient survival, and stent failure-free survival rates of D-SEMS versus EUS-GE.  

Ninety-seven patients were included in the D-SEMS group and 79 in the EUS-GE group. Pancreatic cancer was the etiology of GOO in 53.4% of patients. Both technical and clinical success rates were similar between the D-SEMS and EUS-GE groups (92.8% vs 93.7% and 83.5% vs 92.4%, respectively). Additionally, the adverse event rates did not differ between the groups (10.3% vs 10.1%); however, 2 patients from the EUS-GE group required surgical management. At 3 months, patients who underwent EUS-GE experienced improved stent patency compared with patients in the D-SEMS group (92.23% vs 80.6%; adjusted hazard ratio, 0.37; P=.033).

Vanessa M. Shami, MD, FASGE


This study suggests that in patients with malignant GOO, EUS-GE provides superior stent patency at 3 months versus D-SEMS, with comparable technical and clinical success and adverse events. It is imperative to acknowledge that performing EUS-GE requires a higher level of technical expertise than D-SEMS placement. Large prospective comparative trials are needed to substantiate the above results.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Sánchez-Aldehuelo R, Subtil Iñigo JC, Moreno BM, et al. EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: results from a nationwide multicenter retrospective study. Gastrointest Endosc 2022 Jul 20. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.07.018)

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