S73 Prevalence and Clinical Impact of Sarcopenia and Myosteatosis in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Endoscopic Palliation of Gastric Outlet Obstruction

Introduction: Malnutrition is common in unresectable pancreatic ductal adenocarcinoma (PDAC) with around 50% of patients being sarcopenic and 55% having myosteatosis. Development of gastric outlet obstruction (GOO) can further impair nutrition status. The aim of this study is to identify the prevalence of sarcopenia and myosteatosis in patients with GOO from PDAC and assess their impact on adverse events (AE) and survival following endoscopic GOO palliation. Methods: Patients undergoing endoscopic palliation of GOO from PDAC between January 2017 and February 2025 were retrospectively identified at a single center. Abdominal computed tomography scans were analyzed using a body composition artificial intelligence algorithm. Endoscopic AEs included infection, perforation, bleeding, leak, ulceration, and migration. Myosteatosis was defined as a muscle density <33 Hounsfield units if BMI ≥25 kg/m2 or <41 Hounsfield units if BMI <25 kg/m2. Sarcopenia was defined as a psoas skeletal muscle index <55 cm2/m2 in men or <39 cm2/m2 in women. Analysis was done using Kaplan-Meier method, log rank test, and multivariable logistic regression adjusted for tumor size, metastases, and peritoneal carcinomatosis. Results: The cohort included 132 patients with 83% being sarcopenic, 64% having myosteatosis, and only 5% without sarcopenia or myosteatosis. Endoscopic ultrasound sound-guided gastroenterostomy was performed in 57% of patients with 43% receiving a duodenal stent for GOO palliation. Ninety-day mortality after endoscopic intervention was not impacted by the presence of sarcopenia [odds ratio [OR] 0.94 (0.35-2.51); P = 0.896], myosteatosis [OR 1.48 (0.66-3.32); P = 0.337], or both sarcopenia and myosteatosis [OR 1.42 (0.67-3.03); P = 0.364]. AE risk was higher in the sarcopenia group [OR 5.21 (0.65-41.9); P = 0.121] but was not statistically significant. There was no difference in overall survival after endoscopic intervention in patients with baseline sarcopenia (P = 0.657) or baseline myosteatosis (P = 0.728). Conclusion: Patients with PDAC who develop GOO have a higher prevalence of sarcopenia and myosteatosis compared to rates previously reported in patients with unresectable PDAC. The presence of sarcopenia or myosteatosis at the time of endoscopic GOO palliation did not impact 90-day mortality or adverse event risk.