Robotic Whipple Leverages Robotics for More Precise Pancreatic Tumor Removal

Internationally respected specialists at Orlando Health Digestive Health Institute are concluding the first multicenter, randomized clinical trial comparing endoscopic ultrasound-guided gastroenterostomy (EUS-GE) and surgical gastrojejunostomy in pancreatic cancer patients.

Targeted endoscopic therapies for gastrointestinal malignancies are helping advance surgical oncology.  “Patients with pancreatic cancer can develop gastric outlet obstruction, which are usually treated by surgical gastrojejunostomy,” says Shyam S. Varadarajulu, MD, president of Orlando Health Digestive Health Institute and a renowned expert in gastroenterology. “Endoscopic ultrasound-guided gastroenterostomy is a promising new procedure that may offer high clinical success with lower adverse events.”

Surgical gastrojejunostomy, creating an anastomosis between the stomach and the jejunum, has been the conventional bypass methodology for palliative treatment of gastric outlet obstruction. Using highly technical but less invasive endosonographic techniques to access the jejunum, EUS-GE inserts a lumen-apposing metal stent to create the gastrojejunal bypass. “In this trial, we compared EUS-GE to surgical bypass to identify the most optimal approach for treatment of malignant gastric outlet obstruction,” says Dr. Varadarajulu.

In this international, multicenter, randomized trial, 74 patients have been successfully randomized to EUS-GE or surgical gastrojejunostomy at Orlando Health; West Virginia University in Morgantown; RUSH University in Chicago; Asian Institute of Gastroenterology in Hyderabad, India; Medanta Medical Center in New Delhi, India; and University of Hamburg in Germany. The principal investigator for this clinical trial is Ji Young Bang, MD, interventional endoscopist and director of clinical research at Orlando Health Digestive Health Institute.

The primary endpoint of clinical superiority is composite of inability to tolerate soft solid diet prior to hospital discharge, need for endoscopic/surgical reinterventions or supplemental nutrition and procedure-related adverse events. The findings of this landmark clinical trial are expected to have significant implications for care of patients with advanced pancreatic cancer worldwide. The study findings are expected to be published in summer of 2025.

A referral center of excellence, Orlando Health Digestive Health Institute offers comprehensive and coordinated care for a multitude of digestive diseases, as well as leading-edge research and world-class education. Specialists provide tertiary clinical care across all subspecialty and general gastroenterology to evaluate, diagnose and treat a wide range of gastrointestinal conditions.