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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a24749802
DOI: 10.1055/a-2474-9802
Original article

Predictive factors for early mortality after EUS-guided gastroenterostomy in malignant gastric outlet obstruction

Hyuk Lee 
1   Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Ringgold ID: RIN36626)
,
Kenneth Hyunsoo Park 
2   Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States (Ringgold ID: RIN22494)
,
Ulysses Rosas
2   Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States (Ringgold ID: RIN22494)
,
Mohamad Othman El Helou
2   Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States (Ringgold ID: RIN22494)
,
Jae Min Lee 
3   Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea (the Republic of)
,
Liliana Bancila
2   Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States (Ringgold ID: RIN22494)
,
Laith H Jamil 
4   Gastroenterology and Hepatology, William Beaumont Hospital - Royal Oak, Royal Oak, United States (Ringgold ID: RIN21818)
,
Quin Liu
2   Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States (Ringgold ID: RIN22494)
,
Rabindra R. Watson
2   Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States (Ringgold ID: RIN22494)
,
Srinivas Gaddam
2   Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States (Ringgold ID: RIN22494)
,
Simon K Lo
2   Karsh Division of Digestive Diseases and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States (Ringgold ID: RIN22494)
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Abstract

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emerged as a potential treatment option for malignant gastric outlet obstruction (mGOO), with a relatively long duration of patency and low rate of reintervention. Its intrinsic risk for serious adverse events and high procedure cost mandates careful patient selection beyond the common safety profiles. This study aimed to assess for predictors of early post-EUS-GE mortality.

Patients and methods We conducted a retrospective analysis of all patients with unresectable mGOO who underwent EUS-GE. Predictive factors for postoperative 30-day mortality with crude and adjusted hazard ratios were examined using univariate and multivariate penalized likelihood Firth logistic regression analyses.

Results Technical and clinical success was achieved in 96.7% and 93.1% of the patients, respectively. The 30-day mortality rate after the procedure was 11.7%, and no procedure complications were observed. The 30-day mortality group had a significantly low rate of initial clinical success (66.7% vs. 96.2%, P = 0.007). Univariate analysis identified significantly higher postoperative 30-day mortality in patients with poor baseline ECOG performance status scale (≥ 2) and ascites. Presence of grade 2 ascites was confirmed as an independent predictive factor in the multivariate analysis (adjusted hazard ratio 52.41, 95% confidence interval 1.55 to 1775.64, P = 0.024).

Conclusions EUS-GE should be carefully considered for patients with ascites which was an independent predictor for early mortality after procedure in mGOO, especially those with grade 2 or higher level of ascites.

Keywords

Endoscopy Upper GI Tract - Dilation, injection, stenting - Endoscopic ultrasonography - Intervention EUS - Pancreatobiliary (ERCP/PTCD) - Strictures - Malignant strictures

Supplementary Material



Publication History

Received: 17 June 2024

Accepted after revision: 15 November 2024

Accepted Manuscript online:
18 November 2024

Article published online:
13 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Hyuk Lee, Kenneth Hyunsoo Park, Ulysses Rosas, Mohamad Othman El Helou, Jae Min Lee, Liliana Bancila, Laith H Jamil, Quin Liu, Rabindra R. Watson, Srinivas Gaddam, Simon K Lo. Predictive factors for early mortality after EUS-guided gastroenterostomy in malignant gastric outlet obstruction. Endosc Int Open 2025; 13: a24749802.
DOI: 10.1055/a-2474-9802
 

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