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Randomized Controlled Trial
. 2025 Dec 5;75(1):24-32.
doi: 10.1136/gutjnl-2025-336339.

Endoscopic or surgical gastroenterostomy for malignant gastric outlet obstruction: a randomised trial

Ji Young Bang  1 , Rajesh Puri  2 , Sundeep Lakhtakia  3 , Shyam Thakkar  4 , Irving Waxman  5 , Imran Siddiqui  6 , Kristen Arnold  6 , Adarsh Chaudhary  7 , Shubham Mehta  2 , Amanjeet Singh  7 , Guduru Venkat Rao  8 , Jahangeer Basha  3 , Rajesh Gupta  3 , Shreeyash Modak  8 , Shailendra Singh  4 , Brian Boone  9 , Philip Dautel  10 , Matthew E B Dixon  11 , Hyungjin Myra Kim  12 , Bryce Sutton  1 , Juan Pablo Arnoletti  6 , Thomas Rösch  10 , Shyam Varadarajulu  13
Affiliations
Randomized Controlled Trial

Endoscopic or surgical gastroenterostomy for malignant gastric outlet obstruction: a randomised trial

Ji Young Bang et al. Gut. .

Abstract

Background: Although surgical gastrojejunostomy (SGJ) is the standard method for palliation of gastric outlet obstruction (GOO), an endoscopic method-endoscopic ultrasound-guided gastroenterostomy (EUS-GE)-has been proposed as a novel, less invasive approach.

Objective: We compared both methods to determine whether clinical outcomes for EUS-GE are superior to surgery.

Design: We conducted a multicentre, randomised superiority trial of patients with malignant GOO to receive either EUS-GE or SGJ. Primary endpoint was composite measure, consisting of Gastric Outlet Obstruction Scoring System (GOOSS) score of 0 or 1 at hospital discharge, need for reinterventions or supplemental nutrition, or procedure-related adverse events during 6-month follow-up or until death. Secondary endpoints were time to solid diet, length of hospitalisation, health-related quality of life (HRQoL) and treatment costs.

Results: 74 patients were randomly assigned to EUS-GE (38 patients) or SGJ (36 patients). Primary endpoint occurred in 7.9% of patients who received EUS-GE and 38.9% in SGJ (risk difference -31.0%, 95% CI -47.6% to -11.4%, p=0.002). EUS-GE was associated with more rapid advancement to solid diet (median 2 days (P25-P75, 2-3) vs 5 days (P25-P75, 3.5-9)), shorter hospitalisation (median 3 days (P25-P75, 3-6) vs 9 days (P25-P75, 6-12.5)), better HRQoL for physical (p=0.0016) and social functioning (p=0.011) and lower treatment costs (US$33 934 vs US$51 437, difference -US$17 503 (95% CI -US$27 807 to -US$7920)).

Conclusion: In this randomised trial, EUS-GE was superior to SGJ with regards to oral intake, need for reinterventions or supplemental nutrition, length of hospitalisation, quality of life and treatment costs.

Trial registration number: NCT05548114.

Keywords: ENDOSCOPIC ULTRASONOGRAPHY; GASTROINTESTINAL SURGERY; INTESTINAL OBSTRUCTION; PANCREATIC CANCER; RANDOMIZED CONTROLLED TRIAL.

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Conflict of interest statement

Competing interests: JYB: Consultant for Olympus America Inc. and Boston Scientific Corporation. SV: Consultant for Boston Scientific Corporation, Olympus America Inc. and Medtronic. ST: Consultant for Boston Scientific Corporation, Guidepoint and Medtronic. TR: Consultant for Olympus, Fujifilm, Erbe and Falk. IW: Consultant for Cook Medical and Advisory Board for Magentiq Eye. SS: Consultant for Boston Scientific Corporation, Apollo Endosurgery Inc. and Fujifilm. RP, SL, IS, KA, AC, SM, AS, GVR, JB, RG, SM, BB, PD, MEBD, HMK, BS and JPA: No competing interests to declare.

Figures

Figure 1
Figure 1. Methods of treatment for gastric outlet obstruction. Panel A shows the endoscopic ultrasound-guided gastroenterostomy approach, in which a lumen-apposing metal stent is placed into the jejunum from the gastric lumen. Panel B shows the surgical gastrojejunostomy approach.
Figure 2
Figure 2. Consort flow diagram of study participants and follow-up. EUS, endoscopic ultrasound.
See this image and copyright information in PMC

References

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