A National Perspective on Palliative Interventions for Malignant Gastric Outlet Obstruction.

Abstract

Background: Approximately 15-20% of patients with duodenal or periampullary malignancies develop GOO. While small, randomized trials have reported more rapid recovery and shorter hospital stay with ES, limited studies have evaluated outcomes on a national level. The present study characterized short-term clinical and financial outcomes associated with gastrojejunostomy (GJ) versus endoscopic stenting (ES) in malignant gastric outlet obstruction (GOO).

Methods: Adults with malignant GOO treated with ES or GJ were identified in the 2016-2020 Nationwide Readmissions Database. Entropy balancing was used to balance covariates between groups, and multivariable regression was used to evaluate the association between GJ or ES and in-hospital mortality, total parenteral nutrition (TPN) use, complications, length of stay (LOS), costs, and 90-day readmission.

Results: Of 8,186 GOO patients, 68.4% underwent ES and 31.6% GJ. The cohorts were similar in age, sex, and comorbidities, while GJ patients were more commonly frail. After risk adjustment, mortality, composite complications, and 90-day readmission were comparable between GJ and ES. GJ was associated with greater odds of blood transfusion (AOR 1.74 [95% CI [1.37-2.21]) and postoperative TPN use (AOR 3.76 [95% CI 2.64-5.35]). Furthermore, GJ patients experienced a significant increment of +$15,800 in costs and +6.9-day in LOS. On subgroup analysis of patients with metastatic disease, mortality, complications, and readmission remained comparable between palliation strategies.

Conclusions: ES appears to yield comparable short-term morbidity and mortality relative to GJ with significant cost reduction. Increasing access to endoscopic technology and regionalizing care to high-volume centers may help improve outcomes for patients with malignant GOO.