Aims
Endoscopic ultrasound–guided gastroenterostomy (EUS-GE) is effective for palliation of malignant gastric outlet obstruction (mGOO). Though costlier and invasive, it offers a chance at better quality of life. We aim to define predictors of poor survival following EUS GE.
Methods
Thirty-two consecutive patients undergoing EUS-GE for mGOO at the National University Health System (Singapore) over two years were analysed. Uni- and multivariate analyses evaluated factors associated with 30-day mortality.
Results
Technical and clinical success was 90.6%. GOO scores improved from 0.25 ± 0.51 to 2.72 ± 0.52, with time to soft diet taking 2.42 ± 1.82 days. BMI < 20 predicted 30-day mortality (p=0.03). ECOG 4 was strongly associated with 30-day mortality (OR 27.0, 95% CI 1.26–578; p=0.035) (Table 1). Multi-visceral metastases, ascites, and pre-procedure drainage were not predictive. Patients with ECOG 3–4 and BMI < 20 showed less improvement in GOO scores at discharge(2.14 vs 2.88; p=0.015), higher 30-day mortality risk (OR 7.0; p=0.038), and shorter median survival (30 ± 6 vs 79 ± 35 days; log rank p=0.033) (Figure 1).
|
Variables |
Patients, n |
Events, n |
Crude OR (95% CI) |
Adjusted OR (95% CI) |
|
BMI |
|
|
|
|
|
BMI > 20 |
10 |
0 |
NA |
|
|
BMI < 20 |
22 |
8 |
1 |
|
|
Technical Success |
|
|
|
|
|
Success |
29 |
7 |
0.636 (0.05 – 8.12) |
|
|
Failure |
3 |
1 |
1 |
|
|
Clinical Success |
|
|
|
|
|
Success |
29 |
6 |
0.130 (0.01 – 1.69) |
|
|
Failure |
3 |
2 |
1 |
|
|
ECOG |
|
|
|
|
|
ECOG 1 |
16 |
1 |
1 |
1 |
|
ECOG 2 |
4 |
2 |
15 (0.89 – 251) |
9.0 (0.52 – 155) |
|
ECOG 3 |
7 |
2 |
6.0 (0.44 – 81.2) |
9.0 (0.52 – 155) |
|
ECOG 4 |
5 |
3 |
22.5 (1.51 – 335) |
27 (1.26 – 578) |
|
|
||||
|
|
||||
|
Presence of Ascites |
|
|
|
|
|
Grade 0 |
18 |
5 |
1 |
|
|
Grade 1 |
0 |
0 |
0 |
|
|
Grade 2 |
12 |
3 |
0.867 (0.16 – 4.57) |
|
|
Grade 3 |
2 |
0 |
0 |
|
|
NGT drainage |
|
|
|
|
|
Yes |
22 |
6 |
1.5 (0.25 – 9.18) |
|
|
No |
10 |
2 |
1 |
|
|
|
|
|
|
|
|
High Risk Subgroup |
7 |
4 |
7.0 (1.11 – 44.1) |
|
|
Low Risk Subgroup |
25 |
4 |
1 |
|
Conclusions
Disease burden does not affect short term survival after EUS-GE. Patients with ECOG 3–4 and BMI < 20 experienced limited symptomatic improvement and high early mortality, suggesting EUS-GE may offer limited benefit in this subgroup.