Endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) has recently been shown to be superior to enteral stenting and surgery for management of gastric outlet obstruction (GOO). Outcomes outside of randomised trials is limited. We aimed to assess the outcomes from EUS-GJ for management of malignant gastric outlet obstruction in 2 UK centres.

Retrospective analysis of patients undergoing EUS-GJ was conducted in 2 tertiary centres. Information was collected including demographics, indication, sedation, pre- and post- GOOS score, stent size, technique used, number of days to commencing diet, adverse events, reintervention rate, other interventions required, receipt of oncological treatment and survival. Univariate analysis was performed to assess pre- and post-procedure GOOS scores. Survival was assessed using Kaplan-Meier curves and assessment of factors associated with survival using Cox regression analysis.

46 patients were included with mean age 68.8 year and 22 females. The majority were for obstruction due to pancreaticobiliary cancer (n=38) and 23 were performed under anaesthesia and 23 sedation. Median pre-procedure GOOS score was 0.5 (IQR 0 – 1). Technical success was achieved in 44/46 (95.6%) with 2 stents having a type 1 maldeployment (1 managed endoscopically with subsequent success). Median GOOS score rose to 3 (IQR 3 – 3, p<0.0001) post-procedure with a median of 1 day to full diet. Overall 7-day adverse event rate was 4/46 (8.7%) which were maldeployment (2), acute kidney injury (1) and failure to improve (1). 21/46 (45.7%) also required biliary intervention. Overall survival was 113 days which was shorter in those needing biliary intervention (97 days biliary vs. 150 days non-biliary, p=0.3). Improved survival was associated with subsequently receiving chemotherapy (HR 1.2, 95% confidence interval 1.07 – 1.6, p=0.0004).

EUS-GJ is an effective intervention for malignant gastric outlet obstruction showing significant improvement in GOOS scores and early return to full diet. Adverse event

rates are low and allows receipt of chemotherapy which improves survival. Larger studies are needed to determine factors affecting survival.