Endoscopic ultrasound‐guided balloon‐occluded gastrojejunostomy bypass, duodenal stent or laparoscopic gastrojejunostomy for unresectable malignant gastric outlet obstruction

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Abstract
Objectives: Malignant gastric outlet obstruction (GOO) can be relieved by either laparoscopic gastrojejunostomy (LGJ), endoscopic stenting (SEMS) or endoscopic ultrasound‐guided gastrojejunostomy (endoscopic ultrasound‐guided balloon‐occluded gastrojejunostomy bypass; EPASS). This study aimed to compare the outcomes of the three treatment methods.Methods: This was a retrospective study of patients who suffered from malignant GOO between January 2012 to November 2020 that received either EPASS, LGJ or SEMS. The outcomes included the technical and clinical success, 30‐day adverse events and mortality, pre and post stenting GOO scores (GOOSs), stent patency and causes of stent dysfunction.Results: One hundred and fourteen patients were included (30 EPASS, 35 LGJ, 49 SEMS). The technical success of EPASS, LGJ and SEMS were 93.3%, 100%, 100% (P = 0.058) and clinical success rates were 93.3%, 80%, 87.8% (P = 0.276), respectively. Procedural time was longest for the LGJ group (P < 0.001). The EPASS group had the shortest hospital stay (EPASS 1.5 [1–17], LGJ 7 [2–44], SEMS 5 [2–46] days, P < 0.001). EPASS group also had the lowest rates of recurrent obstruction (EPASS 3.3%, LGJ 17.1%, SEMS 36.7%, P = 0.002) and re‐intervention (EPASS 3.3%, LGJ 17.1%, SEMS 26.5%, P = 0.031). The 1‐month GOOS was highest in the EPASS group (EPASS 3 [1–3], LGJ 3 [0–3], SEMS 2 [0–3], P = 0.028).Conclusion: Endoscopic ultrasound‐guided gastrojejunostomy was associated with better clinical outcomes then the other two procedures. The procedure may be the best option provided that the expertise is available.

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