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Does EUS-Guided Gastroenterostomy Improve Quality of Life in Patients With Malignant Gastric Outlet Obstruction?

Vanessa M. Shami, MD, FASGE reviewing Garcia-Alonso FJ, et al. Gastrointest Endosc 2023 Feb 18.

Malignant gastric outlet obstruction (GOO) has a profound negative impact on quality of life (QoL). Options for palliation include surgical gastroenterostomy, enteral stent placement, and, most recently, endoscopic ultrasound-guided gastroenterostomy (EUS-GE). This multicenter prospective trial primarily aimed to study the impact of EUS-GE on patient QoL. Secondary outcomes were all-cause mortality, readmission, and adverse event rates.

Sixty-four patients with unresectable malignant GOO who underwent EUS-GE between August 2019 and May 2021 at 4 Spanish centers were prospectively enrolled. Thirty-three patients were male (51.6%), and the etiology of GOO in most patients was secondary to pancreatic (35.9%) or gastric (31.3%) cancer. 

The European Organization for Research and Treatment of Cancer (EORTC) questionnaire EORTC-QLQ-C30 was used to assess patients at baseline and 1 month after the procedure. Patients received follow-up telephone calls at inclusion and 1, 7, and 30 days after EUS-GE. The Gastric Outlet Obstruction Scoring System (GOOSS) was used to evaluate oral intake, with clinical success defined as a GOOSS ≥2. A linear mixed model assessed differences between baseline and 30-day QoL scores. 

Most patients (n=61, 95.3%) restarted oral intake within 48 hours, and the median postprocedure hospital stay was 3.5 days (interquartile range, 2-5). The 30-day clinical success rate was 83.3%. There was a clinically significant increase of 21.6 points (95% confidence interval, 11.5-31.7) in the global health status scale, with significant improvements in symptoms. Adverse events occurred in 10 patients (15.6%): 6 were self-limiting, 3 required endoscopic reintervention, and 1 patient died.


This multicenter prospectively enrolled study demonstrates that EUS-GE alleviates GOO symptoms in patients with unresectable malignancy. Future prospective trials comparing patient outcomes, such as QoL after EUS-GE with surgical GE or enteral stenting, are warranted in these patients.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Vanessa M. Shami, MD, FASGE

Bio and Disclosures


Garcia-Alonso FJ, Chavarria C, Subtil JC, et al. Prospective multicenter assessment of the impact of EUS-guided gastroenterostomy on patient quality of life in unresectable malignant gastric outlet obstruction. Gastrointest Endosc 2023 Feb 18. (Epub ahead of print) (