S2320 The Impact of Duodenal Versus Jejunal Stent Placement for Endoscopic Ultrasound-Guided Gastroenterostomy

Introduction: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with lumen apposing metal stents (LAMS) is a safe and effective option for the palliation of gastric outlet obstruction (GOO). While the endoscopic procedure was initially intended to replicate surgical gastrojejunostomy (EUS-GJ), it became apparent that the distal duodenum may be a suitable target for endoscopic anastomosis (EUS-GD). As EUS-GD represents a physiologically different approach from surgical GJ, the hypothesis of this study is that EUS-GD is similar to EUS-GJ with respect to clinical outcomes, adverse events (AEs), and reintervention rates. Methods: Patients who underwent EUS-GE for management of GOO between January 2020 and June 2023 were identified from a procedural database at a large referral center. Cases were categorized as having duodenal or jejunal placement of a LAMS during EUS-GE through review of post-procedural cross-sectional imaging. Baseline demographics, clinical variables, and outcomes data were collected. All stents were 15 mm (diameter) × 10 mm (length) in size. The primary outcome was clinical success, defined as the ability to tolerate a diet following EUS-GE. Secondary outcomes were immediate (bleeding, perforation, and death) and delayed (stent obstruction, stent migration) AEs. Continuous and categorical variables were compared using the unpaired t-test and Fisher’s exact test, respectively, with statistical significance at P < 0.05. Results: One hundred and thirty-nine patients were included. Eighty-seven (63%) underwent EUS-GJ and 52 (37%) underwent EUS-GD. There were no significant baseline differences between groups. There was no significant difference between groups for the primary outcome of clinical success (EUS-GD 98% vs EUS-GJ 97%, odds ratio [OR] 1.20, 95% CI 0.1-13.6, P > 0.99) and secondary outcomes of bleeding (4% vs 2%, OR 1.70, 95% CI 0.23-12.4, P = 0.63), death (2% vs 1%, OR 1.69, 95% CI 0.1-27.5, P > 0.99), perforation (6% vs 1%, OR 0.54, 95% CI 0.06–5.4, P = 0.15), and stent obstruction (6% vs 14%, OR 0.38, 95% CI 0.1-1.4, P = 0.17). Conclusion: Clinical success rates overall were excellent, with EUS-GD having comparable outcomes as EUS-GJ. Endoscopists should consider these data alongside other factors, such as the technical feasibility of targeting different bowel loops and the anticipated need for future biliary intervention, when performing EUS-GE.