Endoscopic ultrasound‐guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction
Abstract Objectives Malignant gastric outlet obstruction (GOO) has traditionally been managed with enteral stenting and surgical gastrojejunostomy. Our study aimed to compare outcomes between endoscopic ultrasound‐guided gastrojejunostomy (EUS‐GJ) using a lumen‐apposing metal stent and robotic GJ (R...
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Wiley
2024-04-01
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| Online Access: | https://doi.org/10.1002/deo2.248 |
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| author | Rishi Pawa Nicholas J Koutlas Greg Russell Perry Shen Swati Pawa |
| author_facet | Rishi Pawa Nicholas J Koutlas Greg Russell Perry Shen Swati Pawa |
| author_sort | Rishi Pawa |
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| description | Abstract Objectives Malignant gastric outlet obstruction (GOO) has traditionally been managed with enteral stenting and surgical gastrojejunostomy. Our study aimed to compare outcomes between endoscopic ultrasound‐guided gastrojejunostomy (EUS‐GJ) using a lumen‐apposing metal stent and robotic GJ (R‐GJ) for unresectable malignant GOO. Methods Patients undergoing EUS‐GJ or R‐GJ for unresectable malignant GOO were retrospectively analyzed. The primary outcome was clinical success defined by the ability to tolerate oral intake at the time of discharge. Secondary outcomes included technical success, procedure duration, adverse events, and post‐procedure length of stay (LOS). Results A total of 44 patients met the inclusion criteria. Of the 44, 29 underwent EUS‐GJ and 15 underwent R‐GJ. Age, gender, malignant etiology, and presence of ascites were similar between the two groups. Patients treated with EUS‐GJ had a higher mean Charlson comorbidity index (10.3 vs. 7.0; p ≤ 0.0001) and a lower preoperative body mass index (22.3 vs. 27.2; p = 0.007). Technical and clinical success was achieved in 100% of patients in both groups (p > 0.99). EUS‐GJ was associated with shorter procedure duration (57.5 vs. 146.3 min; p < 0.0001), hospital LOS (4.3 vs. 8.2 days, p = 0.0009), and time to oral intake (1.0 vs. 5.8 days; p < 0.0001) when compared to R‐GJ. Adverse events occurred in 5 of the R‐GJ patients and none of the EUS‐GJ patients (p = 0.003). Conclusions EUS‐GJ has similar efficacy and superior clinical outcomes compared to R‐GJ in the management of malignant GOO. Prospective studies with longer follow‐up duration are needed to validate these findings. |
| format | Article |
| id | doaj-art-8d3901fe5e994121b3f873c8d97dea1c |
| institution | Kabale University |
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| language | English |
| publishDate | 2024-04-01 |
| publisher | Wiley |
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| spelling | doaj-art-8d3901fe5e994121b3f873c8d97dea1c2025-08-20T03:59:36ZengWileyDEN Open2692-46092024-04-0141n/an/a10.1002/deo2.248Endoscopic ultrasound‐guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstructionRishi Pawa0Nicholas J Koutlas1Greg Russell2Perry Shen3Swati Pawa4Department of MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSADepartment of MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSABiostatistics and Data Science Wake Forest School of Medicine Winston‐Salem USADepartment of SurgeryWake Forest School of MedicineWinston‐SalemNorth CarolinaUSADepartment of MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSAAbstract Objectives Malignant gastric outlet obstruction (GOO) has traditionally been managed with enteral stenting and surgical gastrojejunostomy. Our study aimed to compare outcomes between endoscopic ultrasound‐guided gastrojejunostomy (EUS‐GJ) using a lumen‐apposing metal stent and robotic GJ (R‐GJ) for unresectable malignant GOO. Methods Patients undergoing EUS‐GJ or R‐GJ for unresectable malignant GOO were retrospectively analyzed. The primary outcome was clinical success defined by the ability to tolerate oral intake at the time of discharge. Secondary outcomes included technical success, procedure duration, adverse events, and post‐procedure length of stay (LOS). Results A total of 44 patients met the inclusion criteria. Of the 44, 29 underwent EUS‐GJ and 15 underwent R‐GJ. Age, gender, malignant etiology, and presence of ascites were similar between the two groups. Patients treated with EUS‐GJ had a higher mean Charlson comorbidity index (10.3 vs. 7.0; p ≤ 0.0001) and a lower preoperative body mass index (22.3 vs. 27.2; p = 0.007). Technical and clinical success was achieved in 100% of patients in both groups (p > 0.99). EUS‐GJ was associated with shorter procedure duration (57.5 vs. 146.3 min; p < 0.0001), hospital LOS (4.3 vs. 8.2 days, p = 0.0009), and time to oral intake (1.0 vs. 5.8 days; p < 0.0001) when compared to R‐GJ. Adverse events occurred in 5 of the R‐GJ patients and none of the EUS‐GJ patients (p = 0.003). Conclusions EUS‐GJ has similar efficacy and superior clinical outcomes compared to R‐GJ in the management of malignant GOO. Prospective studies with longer follow‐up duration are needed to validate these findings.https://doi.org/10.1002/deo2.248endosonographygastric bypassgastric outlet obstructionrobotic surgical proceduresstents |
| spellingShingle | Rishi Pawa Nicholas J Koutlas Greg Russell Perry Shen Swati Pawa Endoscopic ultrasound‐guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction DEN Open endosonography gastric bypass gastric outlet obstruction robotic surgical procedures stents |
| title | Endoscopic ultrasound‐guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction |
| title_full | Endoscopic ultrasound‐guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction |
| title_fullStr | Endoscopic ultrasound‐guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction |
| title_full_unstemmed | Endoscopic ultrasound‐guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction |
| title_short | Endoscopic ultrasound‐guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction |
| title_sort | endoscopic ultrasound guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction |
| topic | endosonography gastric bypass gastric outlet obstruction robotic surgical procedures stents |
| url | https://doi.org/10.1002/deo2.248 |
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