SP7.05 Palliative surgical, endoscopic and radiological options for the treatment of malignant gastric outlet obstruction: a single-centre outcome analysis

Aims The optimal palliative treatment of malignant gastric outlet obstruction (MGOO) remains controversial. We aimed to assess the outcomes of surgical gastro-jejunostomy (SGJ) and gastro-duodenal stent placed under endoscopic (ES) or fluoroscopic (FS) guidance, in the palliative treatment of MGOO secondary to different types of cancer. Methods Patients with MGOO secondary to advanced cancer from different primary sites – bilio-pancreatic, gastroduodenal, and all other sites – who underwent SGJ, ES or FS, between 2010 and 2021, were included. Post-treatment gastric outlet obstruction score (GOOS) and complications rates were retrospectively compared. A survival analysis was conducted with the Kaplan-Meier method and Cox regression model. Results Of 65 consecutive subjects, 26 underwent SGJ, 20 had ES, 19 FS. Stomach and pancreas were the most common primary cancer sites. The median postoperative GOOS was higher following SGJ (p=0.0006). Early complications occurred in 15.4% of SGJ and 15% of ES. Late complications developed in 3.8% of SGJ, 15% of ES, 5.3% of FS. Stent complications occurred in subjects with gastro-duodenal cancers only. The median survival was 125 days after SGJ, 82 days following ES, 48 days after FS (p=0.031). The probability of overall survival did not differ among groups (p=0.841). Postoperative GOOS ≥1 was a positive predictor of survival. Pre-procedure performance status 2 and chemotherapy were negative predictors. Conclusions In patients with MGOO secondary to cancer from different primary sites, SGJ was associated with a higher clinical success rate and longer median survival than ES and FS. Late stent complications occurred in subjects with gastro-duodenal cancers.