Endoscopic ultrasonography-guided gastroenterostomy: the end of the duodenal stent?

Gastric outlet obstruction is a common complication of (advanced) gastric, duodenal, or pancreatobiliary cancer and leads to decreased quality of life. 1 Schmidt C Gerdes H Hawkins W et al. A prospective observational study examining quality of life in patients with malignant gastric outlet obstruction. Am J Surg. 2009; 198: 92-99 Summary Full Text Full Text PDF PubMed Scopus (52) Google Scholar Traditionally, palliative treatment options for malignant gastric outlet obstruction consist of surgical gastroenterostomy or endoscopic duodenal stenting. In daily clinical practice, a duodenal stent is often placed because it provides rapid relief of symptoms with minimal invasiveness. 2 Jeurnink SM Steyerberg EW van Hooft JE et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc. 2010; 71: 490-499 Summary Full Text Full Text PDF PubMed Scopus (364) Google Scholar However, after placement of a duodenal stent, reinterventions are frequently needed due to stent ingrowth or overgrowth. Over the past decade, therapeutic endoscopic ultrasonography (EUS) has developed rapidly. Consequently, EUS-guided gastroenterostomy (EUS-GE) now offers an alternative, minimally invasive treatment option for patients with malignant gastric outlet obstruction. Because the malignant obstruction is bypassed at a distance from the tumour, it is expected to avoid the risk of recurrent obstruction due to stent ingrowth. Several retrospective comparative studies have suggested that EUS-GE has similar technical success, superior clinical success, and a reduced need for reintervention compared with duodenal stenting. 3 van Wanrooij RLJ Vanella G Bronswijk M et al. Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for malignant gastric outlet obstruction: an international, multicenter, propensity score-matched comparison. Endoscopy. 2022; 54: 1023-1031 Crossref PubMed Scopus (35) Google Scholar , 4 Vanella G Dell'Anna G Capurso G et al. EUS-guided gastroenterostomy for management of malignant gastric outlet obstruction: a prospective cohort study with matched comparison with enteral stenting. Gastrointest Endosc. 2023; 98: 337-347 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar However, randomised controlled trials have been lacking. Endoscopic ultrasonography-guided gastroenterostomy versus uncovered duodenal metal stenting for unresectable malignant gastric outlet obstruction (DRA-GOO): a multicentre randomised controlled trialIn patients with malignant gastric outlet obstruction, EUS-GE can reduce the frequency of reintervention, improve stent patency, and result in better patient-reported eating habits compared with duodenal stenting, and the procedure should be used preferentially over duodenal stenting when expertise and required devices are available. Full-Text PDF