S2159 Symptoms, Rather Than Imaging, Best Predict ERCP Technical Failure in Gastric Outlet Obstruction

Introduction: While Endoscopic retrograde cholangiopancreatography (ERCP) is planned in cancer patients, pre-procedural diagnostic imaging may show signs of gastric outlet obstruction (GOO). The aim of this study was to review outcomes when ERCP is attempted in this setting. Methods: A retrospective review was performed at our tertiary cancer center of ERCP outcomes over a 10-year period (2013-2023) in patients with evidence of GOO or impending GOO (upper gastrointestinal stenosis and/or infiltration, iGOO) on diagnostic imaging within 30 days of ERCP. Results: One hundred fifty-seven patients met inclusion criteria. Mean age was 60.4 ± 12.3 years and 57.3% were men. Frank radiologic signs of GOO were seen in 34.4% while the rest (65.6%) had iGOO. Symptoms of GOO (nausea/vomiting) were noted pre-ERCP in 75.2%. The technical success rate of ERCP was 61.1% (95% confidence interval [CI]: 53.1-68.8%). The cumulative risk of adverse events post-ERCP was 21.0% (95% CI: 14.9-28.2%), the most common being cholangitis and respiratory events. Four deaths were attributable to an ERCP adverse event (3 pneumonia and 1 cholecystitis). Median survival post-ERCP was 64 days (95% CI: 51-87 days). On multivariate analysis, pre-ERCP nausea/vomiting independently predicted lower ERCP technical success rates (OR 0.24 [95% CI: 0.10-0.49], P = 0.0003). There was no significant difference in technical success rates between patients with frank GOO versus iGOO on imaging. Conclusion: In GOO, the presence of symptoms is a strong independent predictor of ERCP technical failure, but the severity of imaging findings are not. There is a relatively higher risk of respiratory adverse events post-ERCP in this patient population.