Background and aims: Retrospective studies on malignant Gastric Outlet Obstruction (mGOO) highlighted several advantages of EUS-guided Gastroenterostomy (EUS-GE) over enteral stenting (ES). However, no prospective evidence is available. The aim of this study was to report on clinical outcomes of EUS-GE in a prospective cohort study, with a subgroup comparison to ES. Methods: All consecutive patients endoscopically treated for mGOO between Dec-2020 and Dec-2022 in a tertiary, academic center were enrolled in a Prospective Registry (PROTECT, NCT04813055) and followed every 30 days to register efficacy/safety outcomes. EUS-GE and ES cohorts were matched according to baseline frailty and oncological disease. Results: 104 patients were treated for mGOO during study interval, of which 70 [male 58.6%; median age=64 [IQR 58-73]; 75.7% pancreatic cancer, 60.0% metastatic] underwent EUS-GE through the Wireless Simplified Technique (WEST). Technical success was 97.1%, whereas clinical success was 97.1% after a median of 1.5 [IQR 1-2] days. Adverse events occurred in 9 (12.9%) patients. After median follow-up of 105 [49-187] days, symptoms recurrence was 7.6%.In the matched comparison versus ES (28 patients per arm), EUS-GE patients experienced higher and faster clinical success (100% vs. 75.0%, p=0.006), reduced recurrences (3.7% vs. 33.3%, p=0.007) and a trend towards shorter time-to-chemotherapy. Conclusions: In this first, prospective, single-center comparison, EUS-GE showed excellent efficacy in relieving mGOO, with an acceptable safety profile and long-term patency, and several clinically significant advantages over ES. Whilst awaiting randomized trials, these results might endorse EUS-GE as first line strategy for mGOO, where adequate expertise is available.

EUS-guided GastroEnterostomy for management of malignant Gastric Outlet Obstruction: a prospective cohort study with matched comparison with Enteral Stenting / Vanella, Giuseppe; Dell'Anna, Giuseppe; Capurso, Gabriele; Maisonneuve, Patrick; Bronswijk, Michiel; Crippa, Stefano; Tamburrino, Domenico; Macchini, Marina; Orsi, Giulia; Casadei-Gardini, Andrea; Aldrighetti, Luca; Reni, Michele; Falconi, Massimo; van der Merwe, Schalk; Arcidiacono, Paolo Giorgio. - In: GASTROINTESTINAL ENDOSCOPY. - ISSN 0016-5107. - (2023). [10.1016/j.gie.2023.04.2072]

EUS-guided GastroEnterostomy for management of malignant Gastric Outlet Obstruction: a prospective cohort study with matched comparison with Enteral Stenting

Vanella, Giuseppe
Primo
;
Dell'Anna, Giuseppe
Secondo
;
Capurso, Gabriele;Crippa, Stefano;Orsi, Giulia;Casadei-Gardini, Andrea;Aldrighetti, Luca
;
Reni, Michele;Falconi, Massimo;Arcidiacono, Paolo Giorgio
Ultimo
2023-01-01

Abstract

Background and aims: Retrospective studies on malignant Gastric Outlet Obstruction (mGOO) highlighted several advantages of EUS-guided Gastroenterostomy (EUS-GE) over enteral stenting (ES). However, no prospective evidence is available. The aim of this study was to report on clinical outcomes of EUS-GE in a prospective cohort study, with a subgroup comparison to ES. Methods: All consecutive patients endoscopically treated for mGOO between Dec-2020 and Dec-2022 in a tertiary, academic center were enrolled in a Prospective Registry (PROTECT, NCT04813055) and followed every 30 days to register efficacy/safety outcomes. EUS-GE and ES cohorts were matched according to baseline frailty and oncological disease. Results: 104 patients were treated for mGOO during study interval, of which 70 [male 58.6%; median age=64 [IQR 58-73]; 75.7% pancreatic cancer, 60.0% metastatic] underwent EUS-GE through the Wireless Simplified Technique (WEST). Technical success was 97.1%, whereas clinical success was 97.1% after a median of 1.5 [IQR 1-2] days. Adverse events occurred in 9 (12.9%) patients. After median follow-up of 105 [49-187] days, symptoms recurrence was 7.6%.In the matched comparison versus ES (28 patients per arm), EUS-GE patients experienced higher and faster clinical success (100% vs. 75.0%, p=0.006), reduced recurrences (3.7% vs. 33.3%, p=0.007) and a trend towards shorter time-to-chemotherapy. Conclusions: In this first, prospective, single-center comparison, EUS-GE showed excellent efficacy in relieving mGOO, with an acceptable safety profile and long-term patency, and several clinically significant advantages over ES. Whilst awaiting randomized trials, these results might endorse EUS-GE as first line strategy for mGOO, where adequate expertise is available.
2023
Gastric Outlet Obstruction
Gastroenterostomy
LAMS
Pancreatic neoplasms
Stent
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/146596
Citazioni
  • ???jsp.display-item.citation.pmc??? 7
  • Scopus 12
  • ???jsp.display-item.citation.isi??? 11
social impact