SpringerLink
Log in

Surgical versus endoscopic gastroenterostomy for gastric outlet obstruction: a retrospective multicentric comparative study of technical and clinical success

  • Brief Report
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Gastric outlet obstruction (GOO) is mainly due to advanced malignant disease. GOO can be treated by surgical gastroenterostomy (SGE), endoscopic enteral stenting (EES), or endoscopic ultrasound-guided gastroenterostomy (EUS-GE) to improve the quality of life.

Methods

Between 2009 and 2022, patients undergoing SGE or EUS-GE for GOO were included at three centers. Technical and clinical success rates, post-procedure adverse events (AEs), length of hospital stay (LOS), 30-day all-cause mortality, and recurrence of GOO were retrospectively analyzed and compared between SGE and EUS-GE. Predictive factors for technical and clinical failure after SGE and EUS-GE were identified.

Results

Of the 97 patients included, 56 (57.7%) had an EUS-GE and 41 (42.3%) had an SGE for GOO, with 62 (63.9%) GOO due to malignancy and 35 (36.1%) to benign disease. The median follow-up time was 13,4 months (range 1 days-106 months), with no difference between the two groups (p = 0.962). Technical (p = 0.133) and clinical (p = 0.229) success rates, severe morbidity (p = 0.708), 30-day all-cause mortality (p = 0.277) and GOO recurrence (p = 1) were similar. EUS-GE had shorter median procedure duration (p < 0.001), lower post-procedure ileus rate (p < 0.001), and shorter median LOS (p < 0.001) than SGE. In univariate analysis, no risk factors for technical or clinical failure in SGE were identified and abdominal pain reported before the procedure was a risk factor for technical failure in the EUS-GE group. No risk factor for clinical failure was identified for EUS-GE. In the subgroup of GOO due to benign disease, SGE was associated with better technical success (p = 0.035) with no difference in clinical success rate compared to EUS-GE (p = 1).

Conclusion

EUS-GE provides similar long-lasting symptom relief as SGE for GOO whether for benign or malignant disease. SGE may still be indicated in centers with limited experience with EUS-GE or may be reserved for patients in whom endoscopic technique fails.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

No datasets were generated or analysed during the current study.

References

  1. Carbajo AY, Kahaleh M, Tyberg A (2020) Clinical review of EUS-guided gastroenterostomy (EUS-GE). J Clin Gastroenterol 54:1–7. https://doi.org/10.1097/MCG.0000000000001262

    Article  PubMed  Google Scholar 

  2. Del Piano M, Ballarè M, Montino F et al (2005) Endoscopy or surgery for malignant GI outlet obstruction? Gastrointest Endosc 61:421–426. https://doi.org/10.1016/s0016-5107(04)02757-9

    Article  PubMed  Google Scholar 

  3. Pinto Pabón IT, Díaz LP, Ruiz De Adana JC, López Herrero J (2001) Gastric and duodenal stents: follow-up and complications. Cardiovasc Intervent Radiol 24:147–153. https://doi.org/10.1007/s002700001742

    Article  PubMed  Google Scholar 

  4. Park KB, Do YS, Kang WK et al (2001) Malignant obstruction of gastric outlet and duodenum: palliation with flexible covered metallic stents. Radiology 219:679–683. https://doi.org/10.1148/radiology.219.3.r01jn21679

    Article  CAS  PubMed  Google Scholar 

  5. Troncone E, Fugazza A, Cappello A et al (2020) Malignant gastric outlet obstruction: which is the best therapeutic option? World J Gastroenterol 26:1847–1860. https://doi.org/10.3748/wjg.v26.i16.1847

    Article  PubMed  PubMed Central  Google Scholar 

  6. Khashab M, Alawad AS, Shin EJ et al (2013) Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 27:2068–2075. https://doi.org/10.1007/s00464-012-2712-7

    Article  PubMed  Google Scholar 

  7. Van Heek NT, van Geenen RCI, Busch ORC, Gouma DJ (2002) Palliative treatment in peri-pancreatic carcinoma: stenting or surgical therapy? Acta Gastroenterol Belg 65:171–117

    PubMed  Google Scholar 

  8. Schmidt C, Gerdes H, Hawkins W et al (2009) A prospective observational study examining quality of life in patients with malignant gastric outlet obstruction. Am J Surg 198:92–99. https://doi.org/10.1016/j.amjsurg.2008.09.030

    Article  PubMed  Google Scholar 

  9. Ly J, O’Grady G, Mittal A et al (2010) A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc 24:290–297. https://doi.org/10.1007/s00464-009-0577-1

    Article  PubMed  Google Scholar 

  10. Wilson RG, Varma JS (1992) Laparoscopic gastroenterostomy for malignant duodenal obstruction. Br J Surg 79:1348. https://doi.org/10.1002/bjs.1800791235

    Article  CAS  PubMed  Google Scholar 

  11. Watanapa P, Williamson RC (1992) Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg 79:8–20. https://doi.org/10.1002/bjs.1800790105

    Article  CAS  PubMed  Google Scholar 

  12. Johnsson E, Thune A, Liedman B (2004) Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World J Surg 28:812–817. https://doi.org/10.1007/s00268-004-7329-0

    Article  PubMed  Google Scholar 

  13. Van Hooft JE, Uitdehaag MJ, Bruno MJ et al (2009) Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc 69:1059–1066. https://doi.org/10.1016/j.gie.2008.07.026

    Article  PubMed  Google Scholar 

  14. Brimhall B, Adler DG (2011) Enteral stents for malignant gastric outlet obstruction. Gastrointest Endosc Clin N Am 21:389–403 vii–viii. https://doi.org/10.1016/j.giec.2011.04.002

    Article  PubMed  Google Scholar 

  15. Lee H, Min B-H, Lee JH et al (2015) Covered metallic stents with an anti-migration design vs. uncovered stents for the palliation of malignant gastric outlet obstruction: a multicenter, randomized trial. Am J Gastroenterol 110:1440–1449. https://doi.org/10.1038/ajg.2015.286

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Jeurnink SM, Steyerberg EW, van Hooft JE et al (2010) Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 71:490–499. https://doi.org/10.1016/j.gie.2009.09.042

    Article  PubMed  Google Scholar 

  17. Nagaraja V, Eslick GD, Cox MR (2014) Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction-a systematic review and meta-analysis of randomized and non-randomized trials. J Gastrointest Oncol 5:92–98. https://doi.org/10.3978/j.issn.2078-6891.2014.016

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jeurnink SM, van Eijck CHJ, Steyerberg EW et al (2007) Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol 7:18. https://doi.org/10.1186/1471-230X-7-18

    Article  PubMed  PubMed Central  Google Scholar 

  19. van Halsema EE, Rauws EAJ, Fockens P, van Hooft JE (2015) Self-expandable metal stents for malignant gastric outlet obstruction: a pooled analysis of prospective literature. World J Gastroenterol 21:12468–12481. https://doi.org/10.3748/wjg.v21.i43.12468

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dormann A, Meisner S, Verin N, Wenk Lang A (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36:543–550. https://doi.org/10.1055/s-2004-814434

    Article  CAS  PubMed  Google Scholar 

  21. Costamagna G, Tringali A, Spicak J et al (2012) Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry. Dig Liver Dis 44:37–43. https://doi.org/10.1016/j.dld.2011.08.012

    Article  CAS  PubMed  Google Scholar 

  22. Mintziras I, Miligkos M, Wächter S et al (2019) Palliative surgical bypass is superior to palliative endoscopic stenting in patients with malignant gastric outlet obstruction: systematic review and meta-analysis. Surg Endosc 33:3153–3164. https://doi.org/10.1007/s00464-019-06955-z

    Article  PubMed  Google Scholar 

  23. Minata MK, Bernardo WM, de Rocha RS P, et al (2016) Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review. Endosc Int Open 4:E1158–E1170. https://doi.org/10.1055/s-0042-115935

    Article  PubMed  PubMed Central  Google Scholar 

  24. Binmoeller KF, Shah JN (2012) Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study. Endoscopy 44:499–503. https://doi.org/10.1055/s-0032-1309382

    Article  CAS  PubMed  Google Scholar 

  25. Itoi T, Ishii K, Ikeuchi N et al (2016) Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction. Gut 65:193–195. https://doi.org/10.1136/gutjnl-2015-310348

    Article  PubMed  Google Scholar 

  26. Khashab MA, Kumbhari V, Grimm IS et al (2015) EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc 82:932–938. https://doi.org/10.1016/j.gie.2015.06.017

    Article  PubMed  Google Scholar 

  27. Tyberg A, Kumta N, Karia K et al (2015) EUS-guided gastrojejunostomy after failed enteral stenting. Gastrointest Endosc 81:1011–1012. https://doi.org/10.1016/j.gie.2014.10.018

    Article  PubMed  Google Scholar 

  28. Khashab MA, Tieu AH, Azola A et al (2015) EUS-guided gastrojejunostomy for management of complete gastric outlet obstruction. Gastrointest Endosc 82:745. https://doi.org/10.1016/j.gie.2015.05.017

    Article  PubMed  Google Scholar 

  29. Itoi T, Ishii K, Tanaka R et al (2015) Current status and perspective of endoscopic ultrasonography-guided gastrojejunostomy: endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy (with videos). J Hepatobiliary Pancreat Sci 22:3–11. https://doi.org/10.1002/jhbp.148

    Article  PubMed  Google Scholar 

  30. Barthet M, Binmoeller KF, Vanbiervliet G et al (2015) Natural orifice transluminal endoscopic surgery gastroenterostomy with a biflanged lumen-apposing stent: first clinical experience (with videos). Gastrointest Endosc 81:215–218. https://doi.org/10.1016/j.gie.2014.09.039

    Article  PubMed  Google Scholar 

  31. Itoi T, Itokawa F, Uraoka T et al (2013) Novel EUS-guided gastrojejunostomy technique using a new double-balloon enteric tube and lumen-apposing metal stent (with videos). Gastrointest Endosc 78:934–939. https://doi.org/10.1016/j.gie.2013.09.025

    Article  PubMed  Google Scholar 

  32. Tyberg A, Perez-Miranda M, Sanchez-Ocaña R et al (2016) Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 4:E276–281. https://doi.org/10.1055/s-0042-101789

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kouanda A, Binmoeller K, Hamerski C et al (2021) Endoscopic ultrasound-guided gastroenterostomy versus open surgical gastrojejunostomy: clinical outcomes and cost effectiveness analysis. Surg Endosc 35:7058–7067. https://doi.org/10.1007/s00464-020-08221-z

    Article  PubMed  Google Scholar 

  34. Khashab MA, Bukhari M, Baron TH et al (2017) International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open 5:E275–E281. https://doi.org/10.1055/s-0043-101695

    Article  PubMed  PubMed Central  Google Scholar 

  35. Iqbal U, Khara HS, Hu Y et al (2020) EUS-guided gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis. Endosc Ultrasound 9:16–23. https://doi.org/10.4103/eus.eus_70_19

    Article  PubMed  Google Scholar 

  36. Perez-Miranda M, Tyberg A, Poletto D et al (2017) EUS-guided Gastrojejunostomy Versus Laparoscopic Gastrojejunostomy: An International Collaborative Study. J Clin Gastroenterol 51:896–899. https://doi.org/10.1097/MCG.0000000000000887

    Article  PubMed  Google Scholar 

  37. Bronswijk M, Vanella G, van Malenstein H et al (2021) Laparoscopic versus EUS-guided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score-matched comparison (with video). Gastrointest Endosc 94:526–536e2. https://doi.org/10.1016/j.gie.2021.04.006

    Article  PubMed  Google Scholar 

  38. Boghossian MB, Funari MP, De Moura DTH et al (2021) EUS-guided gastroenterostomy versus duodenal stent placement and surgical gastrojejunostomy for the palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis. Langenbecks Arch Surg 406:1803–1817. https://doi.org/10.1007/s00423-021-02215-8

    Article  PubMed  Google Scholar 

  39. van der Merwe SW, van Wanrooij RLJ, Bronswijk M et al (2022) Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 54:185–205. https://doi.org/10.1055/a-1717-1391

    Article  PubMed  Google Scholar 

  40. Jang SH, Lee H, Min B-H et al (2017) Palliative gastrojejunostomy versus endoscopic stent placement for gastric outlet obstruction in patients with unresectable gastric cancer: a propensity score-matched analysis. Surg Endosc 31:4217–4223. https://doi.org/10.1007/s00464-017-5480-6

    Article  PubMed  Google Scholar 

  41. Laurent Monino EP-C-R, Gonzalez J-M et al (2023) Endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stents: a retrospective multicentric comparison of wireless and over-the-wire techniques. Endoscopy 5(11):991–999. https://doi.org/10.1055/a-2119-7529

    Article  Google Scholar 

  42. Chen Y-I, James TW, Agarwal A et al (2018) EUS-guided gastroenterostomy in management of benign gastric outlet obstruction. Endosc Int Open 6:E363–E368. https://doi.org/10.1055/s-0043-123468

    Article  PubMed  PubMed Central  Google Scholar 

  43. James TW, Greenberg S, Grimm IS, Baron TH (2020) EUS-guided gastroenteric anastomosis as a bridge to definitive treatment in benign gastric outlet obstruction. Gastrointest Endosc 91:537–542. https://doi.org/10.1016/j.gie.2019.11.017

    Article  PubMed  Google Scholar 

  44. Fan W, Tan S, Wang J et al (2022) Clinical outcomes of endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a systematic review and meta-analysis. Minim Invasive Ther Allied Technol 31:159–167. https://doi.org/10.1080/13645706.2020.1792500

    Article  PubMed  Google Scholar 

  45. Chen Y-I, Khashab MA (2016) Endoscopic approach to gastrointestinal bypass in malignant gastric outlet obstruction. Curr Opin Gastroenterol 32:365–373. https://doi.org/10.1097/MOG.0000000000000292

    Article  PubMed  Google Scholar 

  46. Chen Y-I, Kunda R, Storm AC et al (2018) EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques. Gastrointest Endosc 87:1215–1221. https://doi.org/10.1016/j.gie.2017.07.030

    Article  PubMed  Google Scholar 

  47. van Wanrooij RLJ, Vanella G, Bronswijk M et al (2022) Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for malignant gastric outlet obstruction: an international, multicenter, propensity score-matched comparison. Endoscopy 54:1023–1031. https://doi.org/10.1055/a-1782-7568

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Hôpital d’Instruction des Armées Laveran, Marseille, France

    Eugénie Martinet & Ghislain Pauleau

  2. APHM Digestive Department, Marseille, France

    Jean-Michel Gonzalez, Jean Hardwigsen, Sophie Chopinet, Vincent Moutardier, Mohamed Gasmi, Marc Barthet & David Jérémie Birnbaum

  3. Department of Gastroenterology and Hepatology, Hôpital L’Archet 2, Nice, France

    Maxime Thobois, Geoffroy Vanbiervliet & Philippe Onana

  4. Public Health Laboratory of the Faculty of Medical and Paramedical Sciences; Epidemiology and Health Economics Department, Hôpital Timone, Marseille, France

    Ilyes Hamouda

  5. Hôpital Nord, Chemin des Bourrely, Marseille cedex 20, 13915, France

    David Jérémie Birnbaum

Authors
  1. Eugénie Martinet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Michel Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maxime Thobois
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilyes Hamouda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean Hardwigsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sophie Chopinet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ghislain Pauleau
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Geoffroy Vanbiervliet
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Philippe Onana
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Vincent Moutardier
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mohamed Gasmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Marc Barthet
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. David Jérémie Birnbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

E.M, J-M.G, M.B et D-J.B made conception and design E.M realised the acquisition of data I.H realised analysis of data E.M, J-M.G, M.B et D-J.B interpreted data E.M, J-M.G, J.H, S.C, G.P, G.V, V.M, M.G, M.B et D-J.B made the revising, realised the final approval of the version to be published and agreement.

Corresponding author

Correspondence to David Jérémie Birnbaum.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martinet, E., Gonzalez, JM., Thobois, M. et al. Surgical versus endoscopic gastroenterostomy for gastric outlet obstruction: a retrospective multicentric comparative study of technical and clinical success. Langenbecks Arch Surg 409, 192 (2024). https://doi.org/10.1007/s00423-024-03365-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00423-024-03365-1

Keywords

Search

Navigation