COMPARISON OF TRENDS AND RESOURCE UTILIZATION IN PATIENTS WITH GASTRIC OUTLET OBSTRUCTION UNDERGOING ENDOSCOPIC VERSUS SURGICAL TREATMENTS

Abdullah Sohail; Ahmad Khan; Khadija Naseem; Adnan Malik; Yousaf Hadi; Sardar M. Shah-Khan; Shyam Thakkar; Shailendra Singh

doi:10.1016/j.gie.2022.04.278

Introduction Endoscopic therapies provide a minimally invasive alternative to surgical procedures in patients with gastric outlet obstruction (GOO) syndrome for both curative and palliative purposes. However, the national-level data on the utilization and hospital-related outcomes of endoscopic therapies in patients with GOO is lacking. Therefore, we conducted a national-level study to assess utilization and hospital-related outcomes of patients with GOO who underwent endoscopic therapies and compared them to surgical procedures utilizing the national inpatient sample (NIS) database. Methods We identified all the adult patients admitted with GOO who underwent endoscopic or surgical procedures utilizing the ICD-10 CM/PCS codes from NIS 2016-2019 database. We included endoscopic dilatation, stenting, and percutaneous gastrostomy/jejunostomy in the endoscopic intervention group. We compared it with the surgery group, which included open or laparoscopic resection or bypass procedures performed for patients with GOO. The primary outcome of our study was to estimate the magnitude of endoscopic procedure utilization for GOO in comparison to surgical procedures, and secondary outcomes included all-cause in-hospital mortality, mean length of stay (LOS), and hospitalization cost. Results A total of 148,075 GOO-related hospitalizations were identified and out of which 35,645 patients (24.07%) underwent endoscopic therapies and 13,179 patients (8.9%) underwent surgical treatment. The majority of the patients were females (52.5% vs. 54.4%), and the mean age was 66.08 years (endoscopic intervention) vs. 62.92 years (surgical intervention). In endoscopy group a total of 14,350(40.0%) underwent percutaneous gastrostomy/jejunostomy, 13,080 (36.6%) patients underwent endoscopic dilatation, and 10,100 (28.33%) patients underwent stenting. The mean length of stay (14.63 vs. 8.99 days), mortality (5.12% vs. 2.31%), and inflation-adjusted hospitalization costs ($41,331 vs. $24,306) were higher in the surgical group as compared to the endoscopic group. Conclusion This study found that the GOO patient undergoing endoscopic interventions have more resource utilization than surgical procedures. The mean length of stay, mortality, and hospitalization costs are strikingly higher in patients undergoing surgical interventions than endoscopic therapies. Hence, minimally invasive endoscopic treatments may be favourable to more invasive surgical procedures.

COMPARISON OF TRENDS AND RESOURCE UTILIZATION IN PATIENTS WITH GASTRIC OUTLET OBSTRUCTION UNDERGOING ENDOSCOPIC VERSUS SURGICAL TREATMENTS

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