P1365 - Symptoms, Rather Than Imaging, Best Predict ERCP Technical Failure in Gastric Outlet Obstruction

George Wahba, MD¹, Sabhi Gull, MD¹, Varun Vemulapalli, MD², Cristina Natha, MD², Jennifer Ma, MD², William Ross, MD¹, Brian Weston, MD¹, Emmanuel Coronel, MD¹, Phillip S.. Ge, MD¹, Jeffrey H.. Lee, MD, MPH¹
1The University of Texas MD Anderson Cancer Center, Houston, TX; 2McGovern Medical School at UTHealth, Houston, TX

Introduction: While ERCP is planned in cancer patients, pre-procedural diagnostic imaging may show signs of gastric outlet obstruction (GOO). The aim of this study was to review outcomes when ERCP is attempted in this setting.

Methods: A retrospective review was performed at our tertiary cancer center of ERCP outcomes over a ten-year period (2013-2023) in patients with evidence of GOO or impending GOO (upper gastrointestinal stenosis and/or infiltration, iGOO) on diagnostic imaging within 30 days of ERCP.

Results: One hundred fifty-seven patients met inclusion criteria. Mean age was 60.4±12.3 years and 57.3% were male. Frank radiologic signs of GOO were seen in 34.4% while the rest (65.6%) had iGOO. Symptoms of GOO (nausea/vomiting) were noted pre-ERCP in 75.2%. The technical success rate of ERCP was 61.1% (95% CI: 53.1-68.8%). The cumulative risk of adverse events post-ERCP was 21.0% (95% CI: 14.9-28.2%), the most common being cholangitis and respiratory events. Four deaths were attributable to an ERCP adverse event (3 pneumonia and 1 cholecystitis). Median survival post-ERCP was 64 days (95% CI: 51-87 days). On multivariate analysis, pre-ERCP nausea/vomiting independently predicted lower ERCP technical success rates (OR 0.24 [95% CI: 0.10-0.49], P=0.0003) (Figure 1). There was no significant difference in technical success rates between patients with frank GOO versus iGOO on imaging.

Discussion: In GOO, the presence of symptoms is a strong independent predictor of ERCP technical failure, but the severity of imaging findings are not. There is a relatively higher risk of respiratory adverse events post-ERCP in this patient population.

Disclosures:
George Wahba indicated no relevant financial relationships.
Sabhi Gull indicated no relevant financial relationships.
Varun Vemulapalli indicated no relevant financial relationships.
Cristina Natha indicated no relevant financial relationships.
Jennifer Ma indicated no relevant financial relationships.
William Ross indicated no relevant financial relationships.
Brian Weston indicated no relevant financial relationships.
Emmanuel Coronel indicated no relevant financial relationships.
Phillip Ge: Aspero Medical – Consultant. Boston Scientific – Consultant. Fujifilm Medical Systems – Consultant. Neptune Medical – Consultant. Ovesco Endoscopy USA – Consultant. UpToDate – Royalties.
Jeffrey Lee indicated no relevant financial relationships.

George Wahba, MD¹, Sabhi Gull, MD¹, Varun Vemulapalli, MD², Cristina Natha, MD², Jennifer Ma, MD², William Ross, MD¹, Brian Weston, MD¹, Emmanuel Coronel, MD¹, Phillip S.. Ge, MD¹, Jeffrey H.. Lee, MD, MPH¹. P1365 - Symptoms, Rather Than Imaging, Best Predict ERCP Technical Failure in Gastric Outlet Obstruction, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.