Abstract：
BACKGROUND: Malignant Gastric Outlet Obstruction (mGOO) has been standardly treated by surgical Gastrojejunostomy (S-GJ) or Endoscopic Stenting (ES). Recently, EUS-Gastrojejunostomy (EUS-GJ) has emerged as an alternative, despite its worldwide diffusion is heterogeneous. The aim of this survey was to assess clinical decision-making around mGOO and to explore current opinions regarding EUS-GJ.
METHODS: An online survey, spread through social networks and EPC newsletter, was created exploring opinions regarding indications, contraindications, benefits/risks, availability of mGOO treatments; 2 case vignettes explored clinical decision-making in different scenarios.
RESULTS: Overall, 290 pancreatologists from 44 countries responded, of whom 35% surgeons and 65% gastroenterologists. The most common treatment for mGOO was ES (86%), followed by laparoscopic GJ (76%). EUS-GJ was accessible to 59% of respondents, with 10% proficient in this technique. Gold-standard treatment for mGOO varied by specialty; 45% of gastroenterologists preferred ES, 20% EUS-GJ, and 10% surgical GJ, while among surgeons, these were 24%, 8%, and 25%, respectively. A higher annual volume of mGOO treated correlated with increased EUS-GJ adoption and reduced surgical advice. For 51%, EUS-GJ will become the primary treatment for mGOO, notably higher among gastroenterologists and high-volume centers. For 14%, EUS-GJ spread will be limited in the future, or used only when ES fails (19%). Life expectancy, disease stage and patient\'s frailty are the main decision driver in therapeutic choice, whereas future surgical resectability does not contraindicate any treatment for 75%. EUS-GJ\'s main advantages were its minimally invasive nature and clinical efficacy, offset by its steep learning curve.
CONCLUSIONS: This survey revealed significant differences in the management of mGOO, depending on specialties, local expertise and treatment volume, suggesting the lack of standardized algorithms. Life expectancy and patients\' frailty are the main decision drivers. Regarding EUS-GJ, its availability remains suboptimal, with learning curve as the main perceived barrier.
METHODS: An online survey, spread through social networks and EPC newsletter, was created exploring opinions regarding indications, contraindications, benefits/risks, availability of mGOO treatments; 2 case vignettes explored clinical decision-making in different scenarios.
RESULTS: Overall, 290 pancreatologists from 44 countries responded, of whom 35% surgeons and 65% gastroenterologists. The most common treatment for mGOO was ES (86%), followed by laparoscopic GJ (76%). EUS-GJ was accessible to 59% of respondents, with 10% proficient in this technique. Gold-standard treatment for mGOO varied by specialty; 45% of gastroenterologists preferred ES, 20% EUS-GJ, and 10% surgical GJ, while among surgeons, these were 24%, 8%, and 25%, respectively. A higher annual volume of mGOO treated correlated with increased EUS-GJ adoption and reduced surgical advice. For 51%, EUS-GJ will become the primary treatment for mGOO, notably higher among gastroenterologists and high-volume centers. For 14%, EUS-GJ spread will be limited in the future, or used only when ES fails (19%). Life expectancy, disease stage and patient\'s frailty are the main decision driver in therapeutic choice, whereas future surgical resectability does not contraindicate any treatment for 75%. EUS-GJ\'s main advantages were its minimally invasive nature and clinical efficacy, offset by its steep learning curve.
CONCLUSIONS: This survey revealed significant differences in the management of mGOO, depending on specialties, local expertise and treatment volume, suggesting the lack of standardized algorithms. Life expectancy and patients\' frailty are the main decision drivers. Regarding EUS-GJ, its availability remains suboptimal, with learning curve as the main perceived barrier.
摘要：
背景：恶性胃出口梗阻（mGOO）已通过外科胃空肠造口术（S-GJ）或内窥镜支架术（ES）进行标准治疗。最近,EUS-胃空肠吻合术（EUS-GJ）已成为一种替代方法，尽管它在世界范围内的扩散是异质的。这项调查的目的是评估围绕mGOO的临床决策，并探讨有关EUS-GJ的最新观点。
方法：在线调查，通过社交网络和EPC通讯传播，创建了关于适应症的探索意见，禁忌症,收益/风险，mGOO治疗的可用性；2例小插图探讨了不同情况下的临床决策。
结果：总体而言，来自44个国家的290名胰腺学家回应，其中35%的外科医生和65%的胃肠病学家。mGOO最常见的治疗方法是ES（86％），其次是腹腔镜GJ（76％）。59％的受访者可以访问EUS-GJ，10%精通这项技术。mGOO的金标准治疗因专业而异；45％的胃肠病学家首选ES，20%EUS-GJ,和10%的外科GJ，而在外科医生中，这些是24%，8%,25%,分别。每年接受的mGOO治疗量增加与EUS-GJ采用率增加和手术建议减少相关。51%，EUS-GJ将成为mGOO的主要治疗手段,尤其是在胃肠病学家和高容量的中心。对于14%，EUS-GJ传播在未来将是有限的，或仅在ES失败时使用(19%)。预期寿命,疾病阶段和患者的虚弱是治疗选择的主要决定因素，而未来的手术可切除性不禁止任何治疗75%。EUS-GJ的主要优点是其微创性和临床疗效,被其陡峭的学习曲线所抵消。
结论：这项调查显示，mGOO的管理存在显着差异，根据专业，当地的专业知识和治疗量，这表明缺乏标准化的算法。预期寿命和患者的虚弱是主要的决定因素。关于EUS-GJ,它的可用性仍然次优，以学习曲线为主要感知障碍。
方法：在线调查，通过社交网络和EPC通讯传播，创建了关于适应症的探索意见，禁忌症,收益/风险，mGOO治疗的可用性；2例小插图探讨了不同情况下的临床决策。
结果：总体而言，来自44个国家的290名胰腺学家回应，其中35%的外科医生和65%的胃肠病学家。mGOO最常见的治疗方法是ES（86％），其次是腹腔镜GJ（76％）。59％的受访者可以访问EUS-GJ，10%精通这项技术。mGOO的金标准治疗因专业而异；45％的胃肠病学家首选ES，20%EUS-GJ,和10%的外科GJ，而在外科医生中，这些是24%，8%,25%,分别。每年接受的mGOO治疗量增加与EUS-GJ采用率增加和手术建议减少相关。51%，EUS-GJ将成为mGOO的主要治疗手段,尤其是在胃肠病学家和高容量的中心。对于14%，EUS-GJ传播在未来将是有限的，或仅在ES失败时使用(19%)。预期寿命,疾病阶段和患者的虚弱是治疗选择的主要决定因素，而未来的手术可切除性不禁止任何治疗75%。EUS-GJ的主要优点是其微创性和临床疗效,被其陡峭的学习曲线所抵消。
结论：这项调查显示，mGOO的管理存在显着差异，根据专业，当地的专业知识和治疗量，这表明缺乏标准化的算法。预期寿命和患者的虚弱是主要的决定因素。关于EUS-GJ,它的可用性仍然次优，以学习曲线为主要感知障碍。
