EUS-Guided Gastroenterostomy for Malignant Gastric Outlet Obstruction: Morphological Classification to Prevent Stent...

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Oncology

Background:

• Stent misdeployment is a major complication in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for malignant gastric outlet obstruction (mGOO).
• Predicting and preventing misdeployment is crucial for successful EUS-GE procedures.

Purpose of the Study:

• To identify predictors of stent misdeployment during EUS-GE for mGOO.
• To evaluate the impact of misdeployment on patient survival.
• To assess the effectiveness of integrated imaging modalities and a stepwise strategy in reducing misdeployment.

Main Methods:

• A multicenter observational study involving 165 patients undergoing EUS-GE for mGOO.
• Assessment of fluoroscopic morphology (FM) and endoscopic ultrasound (EUS) morphology (EM) of the gastrointestinal tract.
• Multivariable analysis to identify predictors of misdeployment and survival.

Main Results:

• The overall adverse event and misdeployment rates were 7.3% and 4.8%, respectively.
• EUS morphology type C was the sole independent predictor of misdeployment (aOR 16.9, p=0.001).
• A stepwise strategy implemented in 2023 resulted in zero misdeployment cases.

Conclusions:

• Stent misdeployment significantly impacts survival in patients undergoing EUS-GE for mGOO.
• Integrated EM and FM risk stratification within a stepwise strategy can effectively minimize misdeployment.
• Optimizing EUS-GE procedures through risk stratification improves clinical outcomes.