An international randomized trial conducted on the effectiveness of endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) compared to conventional duodenal stenting for palliating malignant gastric outlet obstruction.
Key Points from the Article:
Superior Outcomes with EUS-GE: The trial showed that EUS-GE led to better outcomes than duodenal stenting. Specifically, the need for reintervention within six months was significantly lower in the EUS-GE group (4%) compared to the duodenal stent group (29%). Additionally, stent patency was longer, and the gastric outlet obstructive score (GOOS) at one month was significantly better in the EUS-GE group.
Technical and Training Requirements: Despite its effectiveness, EUS-GE is not widely adopted due to its complexity and the need for specialized equipment and training. The procedure requires the EPASS device, which is not broadly available. Endoscopists need supervised training, with at least 25 procedures to achieve proficiency and 40 for mastery.
Study Details and Limitations: The trial was conducted across seven sites in various countries and involved 97 patients with malignant gastric outlet obstruction due to unresectable primary gastroduodenal or pancreatobiliary malignancies. The study’s authors suggest that future research should address the cost-effectiveness of EUS-GE compared to duodenal stenting. However, the results need confirmation outside of international expert centers before EUS-GE can be implemented more widely.
In summary, the study indicates that EUS-GE is a better option than duodenal stenting for treating cancer-related duodenal blockages, offering lower rates of reintervention and better patient outcomes. However, the technique’s complexity and the need for specialized equipment and training limit its widespread adoption.