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EFFICACY OF ENDOSCOPIC ULTRASOUND-GUIDED GASTROJEJUNOSTOMY VERSUS SURGICAL GASTROJEJUNOSTOMY IN PATIENTS WITH ADVANCED MALIGNANT GASTRIC OUTLET OBSTRUCTION
Kanin Sadudeemeechai^*1,2, Pradermchai Kongkam^1,3, Thanawat Luangsukrerk⁴, Suthira Taychakhoonavudh⁵, Nopphol Witvorapong⁶, Setthabutr Eaupanitcharoen⁷, Phatchara Horharin⁷, Phonthep Angsuwatcharakon⁸, Wiriyaporn Ridtitid^1,3, Rungsun Rerknimitr^1,3
1Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Bangkok, Thailand; ²Department of Surgery, Maharat Nakhon Ratchasima Hospital, NakhonRatchasima, NakhonRatchasima, Thailand; ³Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand; ⁴Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand; ⁵Social and Administrative Pharmacy Department, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Bangkok, Thailand; ⁶Center of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Bangkok, Thailand; ⁷Department of Surgery, Maharat Nakhon Ratchasima Hospital, NakhonRatchasima, NakhonRatchasima, Thailand; ⁸Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Background:
Patients with malignant gastric outlet obstruction (MGOO) often present with significant
comorbidities, as reflected by high Charlson Comorbidity Index (CCI) scores, which may
influence the outcomes of therapeutic interventions. Endoscopic ultrasound-guided
gastrojejunostomy (EUS-GJ) has been proposed as a minimally invasive alternative to surgical
gastrojejunostomy (Surgical-GJ), yet the impact of these approaches in a population with high
disease burden remains unclear.

Methods:
We conducted a retrospective analysis of 25 patients with unresectable MGOO treated at two
tertiary care centers (2023–2024). Propensity score matching (1:1) was performed based on
age, sex, CCI, and disease staging. Outcomes evaluated included technical and clinical
success rates, procedural time, length of hospital stay, time to resumption of oral intake, and
complications.

Results:
After matching, 13 patients underwent EUS-GJ and 12 underwent Surgical-GJ. Both groups had
comparable technical and clinical success rates (92.3% vs. 100%, p=1.00). EUS-GJ
demonstrated a shorter procedural time (50 vs. 84 minutes, p=0.046) but showed no significant
differences in hospital stay (13 vs. 14.5 days, p=0.349) or complications (p=0.709). Time to
resumption of oral intake was slightly longer in the EUS-GJ group (2 vs. 1 day, p=0.786). The
high baseline CCI scores in both groups (EUS-GJ: 8.2 ± 0.8; Surgical-GJ: 8.3 ± 0.7) and the
advanced disease stage (100% stage IV) likely contributed to the limited differences in
outcomes.

Conclusion:
In this cohort of patients with advanced MGOO and significant comorbidities, EUS-GJ and
Surgical-GJ yielded comparable outcomes in terms of success rates, complications, and
recovery times. EUS-GJ provided the benefit of shorter procedural time, which is particularly
advantageous in severely ill patients. However, the high disease burden in this population may
attenuate the potential benefits of either approach. Further research is needed to clarify the role
of these procedures in less critically ill populations.


Table 1. Baseline characteristics and outcomes after propensity score-matching analysis

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