Su1286 ENDOSCOPIC ULTRASOUND-GUIDED GASTROJEJUNOSTOMY IS SUPERIOR TO DUODENAL SELF EXPANDABLE METAL STENT FOR PALLITAIVE TREATMENT OF MALIGNANT GASTRIC OUTLET OBSTRUCTTION: A COMPARATIVE CASE CONTROL STUDY

Palliative treatment of malignant gastric outlet obstruction (GOO) is typically obtained by endoscopic placement of a duodenal self expandable metal stent (D-SEMS), with excellent results in the short-term, but with a high incidence of D-SEMS disfunction due to tumor overgrowth in the long-term. Whether endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) may be a better alternative for this type of patients remains to be proved. To compare the performance characteristics of EUS-GJ and D-SEMS for palliation of malignant GOO. Study period: 07/2017-11/2019. Inclusion criteria: Patients undergoing EUS-GJ (Group A) or D-SEMS (Group B) for palliative therapy of malignant GOO at 8 institutions. Exclusion criteria: 1.) EUS-GJ or D-SEMS performed by a non-malignant condition. Technique EUS-GJ: Nasobiliary tube for irrigation of jejunum+EUS-guided hot-axios. Outcomes: 1) Technical-success: successful hot-axios/D-SEMS placement; 2) Clinical-success: ability to resume oral intake after endoscopic therapy; 3) Adverse events(AEs); 4) Long-term patency of stent. All attempts of EUS-GJ/D-SEMS performed were recorded, compared and analyzed in an intention to treat analysis. 92 patients from 8 institutions, meeting study criteria, were included (table). *Stent migration at day 17 and 154. **Perforation at day 0. At 180 days (6 months) follow-up, 86.9% of patients in Group A(EUS-GJ) and 50% of patients in Group B(D-SEMS) had a normal functioning stent (log rank test: p = 0.0025). EUS-GJ appears to have a similar technical and clinical success that D-SEMS for treatment of malignant GOO. Adverse events are more likely to occur in D-SEMS. Stent patency is longer in patients undergoing EUS-GJ.