Prospective multicenter assessment of the impact of EUS-guided gastroenterostomy on patient quality of life in unresectable malignant gastric outlet obstruction
Francisco Javier Garcia-Alonso 1 , Carlos Chavarria 1 , Juan Carlos Subtil 2 , Jose Ramón Aparicio 3 , Victoria Busto Bea 4 , Belén Martinez-Moreno 3 , Juan J Vila 4 , Vanessa Martín-Álvarez 1 , Laura Sanchez-Delgado 1 , Carlos de la Serna-Higuera 1 , Manuel Perez-Miranda 5
Background and aims: Endoscopic ultrasound guided gastroenterostomy (EUS-GE) is increasingly used for malignant gastric outlet obstruction (GOO) in inoperable patients. However, the impact of EUS-GE on patient quality of life (QoL) has not been evaluated prospectively.
Methods: Consecutive patients with unresectable malignant GOO who underwent EUS-GE between August 2019 and May 2021 at four Spanish centers were prospectively assessed using the European Organization for Research and Treatment of Cancer (EORTC) questionnaire EORTC-QLQ-C30 at baseline and 1 month after the procedure. Centralized follow-up via telephone calls was undertaken. Gastric Outlet Obstruction Scoring System (GOOSS) was used to assess oral intake, defining clinical success as a GOOSS≥2. Differences between baseline and 30 days QoL scores were assessed using a linear mixed model.
Results: Sixty-four patients were enrolled, 33 (51.6%) males, median age 77.3 (IQR: 65.5-86.5) years. The most common diagnoses were pancreatic (35.9%) and gastric (31.3%) adenocarcinoma. Thirty-seven (57.9%) patients presented a 2/3 baseline ECOG performance status score. Oral intake was restarted within 48 hours in 61 (95.3%) patients and the median post-procedure hospital stay was 3.5 (IQR: 2-5) days. The 30-day clinical success rate was 83.3%. A clinically significant increase of 21.6 (95% CI: 11.5-31.7) points in the global health status scale was documented, with significant improvements in nausea/vomiting, pain, constipation and appetite loss.
Conclusions: EUS-GE has proven to relieve GOO symptoms in patients with unresectable malignancy, allowing rapid oral intake and hospital discharge. It also provides a clinically relevant increase in QoL scores at 30 days from baseline.
CITATION Gastrointest Endosc. 2023 Feb 18;S0016-5107(23)00262-6. doi: 10.1016/j.gie.2023.02.015