Endoscopic Ultrasound-Guided Gastrojejunostomy as a Primary Treatment Modality for Malignant Gastric Outlet Obstruction: A Large Multicenter Experience.

Objectives: This work aims to describe technical feasibility and clinical outcomes of endoscopic-ultrasound-guided gastrojejunostomy (EUS-GJ) as a first line treatment option for malignant gastric outlet obstruction (mGOO).

Methods: This is a large multicenter study where patients undergoing EUS-GJ across seven tertiary care centers from India were analyzed. The primary outcomes were technical success defined as correct stent placement without any leak, and clinical success defined as improvement in gastric outlet obstruction symptom score (GOOSS) on follow-up. Secondary outcomes were (a) adverse events rates, (b) symptoms recurrence, (c) death on follow-up, and (d) resumption of chemotherapy.

Results: A total of 71 patients underwent EUS-GJ with technical success of 94.3%. After successful stent placement, all patients tolerated oral liquid diet on day 1, whereas 89.5% and 95.5% tolerated oral solid diet on day 2 and day 7, respectively. Overall, 9/71(12.6%) patients had major adverse events, which included maldeployment in 6/71(8.4%). Mean duration of follow-up was 76.13 ± 58.09 days. On follow-up, reintervention was required in two (3%) patients. Around two-thirds of patients gained weight and could resume their chemotherapy post-EUS-GJ. Kaplan-Meier survival analysis showed that post EUS-GJ, mean overall survival (symptom recurrence or death) of 144.39 ± 11.53 days (95% CI 121.7-167.0).

Conclusion: EUS-GJ is an excellent modality for the palliation of mGOO, providing high clinical success with extremely low rates of reintervention and acceptable safety profile. It should be considered as a primary modality for managing these patients, and enteral stent should be reserved for patients where EUS-GJ is not possible.