Comparison of endoscopic and surgical gastrojejunostomy in patients with malignant gastric outlet obstruction: a national cohort analysis (2016-2020).

Background And Aims: Malignant gastric outlet obstruction (MGOO) is an unfortunate adverse event of advanced upper GI malignancies. Historically, surgical gastrojejunostomy (SGJ) has been the procedure of choice to achieve enteral bypass. Recently, endoscopic techniques have gained popularity in the management of MGOO. We aimed to compare periprocedural outcomes between SGJ and endoscopic gastrojejunostomy (EGJ) in patients with MGOO.

Methods: The National Inpatient Sample was queried from 2016 through 2020. The International Classification of Diseases, Tenth Revision, codes were used to identify adult admissions with a principal diagnosis of gastric, pancreatic, or duodenal cancer undergoing EGJ or SGJ. The 2 cohorts were compared for periprocedural adverse events.

Results: Of 20,930 patients undergoing gastrojejunostomy for MGOO, 16,585 underwent SGJ and 4345 underwent EGJ. The SGJ cohort had a higher proportion of patients with pancreatic cancer (36.16% vs 19.56%) and a lower proportion of patients with gastric cancer (55.16% vs 71.99%). A higher percentage of EGJs were performed in the Northeast (20.33% vs 27.66%, P < .001), whereas a smaller percentage of EGJs were performed in the South (30.56% vs 39.52%, P < .001). Between the 2 groups, the difference in mortality rates was not significantly different (0.62; 95% CI, 0.35-1.10; P = .106), but the EGJ group had lower odds of respiratory failure (4.7% vs 7.4%; adjusted odds ratio [aOR], 0.68; 95% CI, 0.48-0.96; P = .032), blood transfusion (9.25% vs 13.74%; aOR, 0.63; 95% CI, 0.48-0.82; P = .001), and peritonitis (2.19% vs 4.5%; aOR, 0.55; 95% CI, 0.33-0.91; P = .022). The EGJ group had lesser hospitalization charges (mean $164,794 vs $183,519; adjusted difference on regression, $16,495; 95% CI, 29,204-3786; P = .011) and shorter hospital stays (mean, 9.88 vs 12.56 days; adjusted difference, 2.24 days; 95% CI, 1.53-2.96; P < .001). The use of EGJ increased over 5 years (16.86% in 2016 to 24.14% in 2020, P for trend = .002), whereas the use of SGJ decreased (83.13% in 2016 to 75.85% in 2020, P for trend = .002).

Conclusions: Compared with SGJ, EGJ is associated with lower rates of periprocedural adverse events, hospitalization charges, and length of stay. For these reasons, EGJ should be strongly considered in managing MGOO.