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. 2024 Oct 2;16(19):3375.
doi: 10.3390/cancers16193375.

Palliation of Gastric Outlet Obstruction in Case of Biliary Obstruction-A Retrospective, Multicenter Study: The B-GOOD Study

Alessandro Fugazza  1 , Marta Andreozzi  1 , Cecilia Binda  2 , Andrea Lisotti  3 , Ilaria Tarantino  4 , Juan J Vila  5 , Carlos Robles Medranda  6 , Arnaldo Amato  7 , Alberto Larghi  8 , Enrique Perez Cuadrado Robles  9 , Giovanni Aragona  10 , Francesco Di Matteo  11 , Roberta Badas  12 , Cesare Hassan  1 , Carmelo Barbera  13 , Benedetto Mangiavillano  14 , Stefano Crinò  15 , Matteo Colombo  1 , Carlo Fabbri  2 , Pietro Fusaroli  3 , Antonio Facciorusso  16 , Andrea Anderloni  17 , Marco Spadaccini  1 , Alessandro Repici  1
Affiliations

Palliation of Gastric Outlet Obstruction in Case of Biliary Obstruction-A Retrospective, Multicenter Study: The B-GOOD Study

Alessandro Fugazza et al. Cancers (Basel). .

Abstract

Background: EUS-guided gastroenterostomy (EUS-GE) is a novel and effective procedure for the management of malignant gastric outlet obstruction (GOO) with more durable results when compared to enteral stenting (ES). However, data comparing EUS-GE to ES in patients already treated with EUS-guided choledocoduodenostomy (EUS-CDS) for distal malignant biliary obstruction (DMBO) are lacking. We aimed to compare outcomes of EUS-GE and ES for the palliation of GOO in this specific population of patients.

Methods: A multicenter, retrospective analysis of patients with DMBO treated by EUS-CDS and subsequent GOO treated by EUS-GE or ES from 2016 to 2021 was conducted. Primary outcomes were overall AEs rate and dysfunction of the EUS-CDS after GOO treatment. Secondary outcomes included clinical success, technical success, procedure duration, length of hospital stay and relapse of GOO symptoms.

Results: A total of 77 consecutive patients were included in the study: 25 patients underwent EUS-GE and 52 underwent ES. AEs rate and patency outcomes of the EUS-CDS after GOO treatment were comparable between the two groups (12.5% vs. 17.3%; p = 0.74). No recurrence of GOO symptoms was registered in the EUS-GE group while 11.5% of ES patients had symptoms recurrence, even if not statistically significant (p = 0.16), after a mean follow-up period of 63.5 days.

Conclusion: EUS-GE and ES are both effective and safe for the palliation of GOO in patients already treated by EUS-CDS for DMBO with no difference in the biliary stent dysfunction rate and overall AEs. EUS-GE is associated with less recurrence of GOO symptoms.

Keywords: EUS-guided choledocoduodenostomy (EUS-CDS); EUS-guided gastroenterostomy (EUS-GE); distal malignant biliary obstruction (DMBO); enteral stenting (ES); gastric outlet obstruction (GOO); pancreatic cancer.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Endoscopic image of a duodenal stenosis in a patient already treated with EUS-BD for DMBO.
Figure 2
Figure 2
Fluoroscopic image of a LAMS positioned in the duodenal bulb for EUS-BD, with a double pig-tail plastic stent inside (stent-in-stent) and a duodenal metal stent positioned for concomitant duodenal stenosis in the same patient.
Figure 3
Figure 3
Fluoroscopic image of two LAMS positioned in the same patient for EUS-BD and EUS-GE for concomitant DMBO and duodenal stenosis.
See this image and copyright information in PMC

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