P2782 - Comparison of Nutritional Parameters, Efficacy, and Safety of Endoscopic Gastrojejunostomy versus Duodenal Self-Expandable Metal Stent for the Management of Malignant Gastric Outlet Obstruction

Jacob Bauss, MD¹, Jad AbiMansour, MD¹, Noppachai Siranart, MD¹, Daniel M. Simadibrata, MD², Ryan Law, DO¹, Andrew Storm, MD¹, Aliana Bofill-Garcia, MD¹, Eric J. Vargas, MD, MS¹, Barham Abu Dayyeh, MD¹, Vinay Chandrasekhara, MD^1
1Mayo Clinic, Rochester, MN; ²Mayo Clinic, Cleveland, OH

Introduction: Malignancy accounts for most gastric outlet obstruction (GOO) with nutrition directly impacting a patient’s candidacy for palliative chemoradiotherapy. Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) or duodenal stent (DS) placement are viable options for GOO palliation. We aim to compare nutritional outcomes, effectiveness, and safety of EUS-GJ versus DS for the palliation of GOO.

Methods: Patients who underwent EUS-GJ (n=114) or DS placement (n=76) for GOO from January 2019 through November 2023 were retrospectively identified and chart reviewed through an electronic medical database at a quaternary care center. Nutritional parameters included weight (kg), body mass index (BMI), serum albumin (g/dL), and hemoglobin (g/dL) which were collected pre-procedure, 2- and 4-weeks post-procedure, or at the closest timepoint. A propensity score-matched cohort was used to match patients by age, sex, GOO etiology, metastatic disease, and peritoneal carcinomatosis. Nutritional data was analyzed using ANCOVA adjusting for baseline levels. Technical success was defined as successful placement of the EUS-GJ or duodenal stent prior to scope removal. Clinical success was defined as the ability of the patient to tolerate an oral diet. Safety outcomes included infection, perforation, leaks, bleeding, pancreatitis, and re-obstruction. Effectiveness and adverse events (AE) were compared using chi-square analysis and student’s t-test.

Results: Most patients had GOO from pancreatic malignancy - 59.7% for EUS-GJ and 47.4% for DS. Propensity score matched cohort of nutritional parameters revealed no significant difference in baseline weights to 4 weeks post procedure (-0.84, CI –2.88 to 1.19), BMI (-0.15, CI –0.98 to 0.68), hemoglobin (0.19, CI –0.28 to 0.67), and albumin (0.02, CI –0.19 to 0.22). Clinical success was achieved more in the EUS-GJ group (97.4% vs. 89.5%, p=0.022). Technical success was 100% for EUS-GJ and 98.7% for DS (p=0.219). AEs occurred in 21.1% of cases in both groups (p=0.975) with re-obstruction being most common (62.5% EUS-GJ and 75% DS, p=0.611). Time from the procedure to the next chemoradiotherapy session was similar (12 days (7-36) EUS-GJ vs. 14.5 days (8.75-22.5) DS, p=0.352).

Discussion: EUS-GJ was more likely to achieve clinical success compared to duodenal stents for palliation of GOO. There was no significant difference in nutritional parameters, adverse event rate, or time to next chemoradiotherapy among the techniques.


Disclosures:


Jacob Bauss, MD¹, Jad AbiMansour, MD¹, Noppachai Siranart, MD¹, Daniel M. Simadibrata, MD², Ryan Law, DO¹, Andrew Storm, MD¹, Aliana Bofill-Garcia, MD¹, Eric J. Vargas, MD, MS¹, Barham Abu Dayyeh, MD¹, Vinay Chandrasekhara, MD¹. P2782 - Comparison of Nutritional Parameters, Efficacy, and Safety of Endoscopic Gastrojejunostomy versus Duodenal Self-Expandable Metal Stent for the Management of Malignant Gastric Outlet Obstruction, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.