Superiority of long-term outcomes of EUS-guided gastroenterostomy over endoscopic stenting for the palliation of malignant gastric outlet obstruction: A prospective cohort study

Background and Objectives: Limited prospective data exist comparing long-term outcomes of endoscopic placement of a self-expandable metallic stent (ES) and EUS-guided gastroenterostomy (EUS-GE) for unresectable malignant gastric outlet obstruction (mGOO). This large-scale study aimed to prospectively compare these 2 procedures with long-term follow-up. Methods: This single-center, prospective study enrolled 152 consecutive patients with unresectable mGOO who underwent ES ( n = 76) or EUS-GE ( n = 76) between August 2021 and January 2024, with follow-up until death or administrative censoring on January 31, 2025. The primary outcome was the reintervention rate, while secondary outcomes included technical and clinical success, changes in the gastric outlet obstruction score (GOOS), adverse events (AEs), and survival. A Cox regression model identified factors associated with reintervention and survival. Results: Both groups had comparable technical and clinical success rates and AEs. After a median follow-up of 121 days (interquartile range, 55–285), the EUS-GE group had a significantly lower reintervention (adjusted hazard ratio, 0.22, P < 0.001), longer stent patency (median, 566 days vs . 195 days; P < 0.001), and greater GOOS improvement (median, 3 vs . 2; P < 0.001) compared with the ES group. Poor performance status, the presence of ascites, and lack of chemotherapy were independent mortality risk factors. Conclusion: Compared with ES, EUS-GE provides longer stent patency, fewer reinterventions, and better relief of GOO symptoms while maintaining a similar safety profile. In an expert setting, EUS-GE should be considered the optimal approach for managing unresectable mGOO, as it offers superior short- and long-term outcomes.