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The following is a summary of “A Comparison of Endoscopic and Surgical Gastrojejunostomy in Patients with Malignant Gastric Outlet Obstruction: A National Cohort Analysis (2016-2020),” published in the January 2025 issue of Gastroenterology by Pinnam et al.

Malignant gastric outlet obstruction (MGOO) is a severe complication of advanced upper gastrointestinal malignancies. While surgical gastrojejunostomy has long been the standard treatment for achieving enteral bypass, endoscopic gastrojejunostomy has emerged as a less invasive alternative. This study compared peri-procedural outcomes between SGJ and EGJ in managing MGOO. Using the National Inpatient Sample (NIS) database from 2016 to 2020, adult hospitalizations with a principal diagnosis of gastric, pancreatic, or duodenal cancer undergoing SGJ or EGJ were identified via ICD-10 codes. A total of 20,930 hospitalizations were analyzed, comprising 16,585 SGJ and 4,345 EGJ cases. The SGJ cohort included a higher proportion of patients with pancreatic cancer (36.16% vs. 19.56%) and a lower proportion with gastric cancer (55.16% vs. 71.99%). Regional differences in procedure utilization were noted, with more EGJs performed in the Northeast (27.66% vs. 20.33%) and fewer in the South (30.56% vs. 39.52%, P<0.001). 

Mortality rates did not differ significantly between groups (P=0.106); however, EGJ was associated with lower odds of respiratory failure (4.7% vs. 7.4%, aOR 0.68, P=0.032), blood transfusion (9.25% vs. 13.74%, aOR 0.63, P=0.001), and peritonitis (2.19% vs. 4.5%, aOR 0.55, P=0.022). Additionally, EGJ was linked to reduced hospitalization charges (mean $164,794 vs. $183,519; adjusted difference $16,495, P=0.011) and shorter hospital stays (mean 9.88 vs. 12.56 days; adjusted difference 2.24 days, P<0.001). Over the study period, the use of EGJ increased significantly (16.86% in 2016 to 24.14% in 2020, P=0.002), while SGJ utilization declined (83.13% in 2016 to 75.85%, P=0.002). These findings highlight the advantages of EGJ over SGJ, including fewer peri-procedural complications, lower healthcare costs, and shorter hospital stays. Given these benefits, EGJ should be strongly considered as a preferred approach for managing malignant gastric outlet obstruction.

Source: sciencedirect.com/science/article/abs/pii/S0016510725000495