Endoscopic ultrasound-guided gastroenterostomy versus surgical gastrojejunostomy in treatment of malignant gastric outlet obstruction: Systematic review and meta-analysis

Abstract

Background and study aims Palliative treatment of malignant gastric outlet obstruction (GOO) has conventionally been with surgical gastrojejunostomy (SGJ). Advent of devices like lumen apposing metal stents has made endoscopic ultrasound-guided gastroenterostomy (EUS-GE) a potential alternative to SGJ for these patients. We performed a systematic review and meta-analysis of studies that compared outcomes of EUS-GE versus SGJ. Methods We performed a comprehensive systematic search of multiple electronic databases and conference proceedings through January 2021 and identified six studies that compared outcomes of EUS-GE versus SGJ in the management of malignant GOO. The rates of technical success, clinical success, and AEs were analyzed, and pooled odds ratios were calculated using random effects model. Results Six studies were included in our analysis with a total of 484 patients, of which 291 underwent EUS-GE and 193 underwent SGJ. The technical success rate of SGJ was superior to EUS-GE (OR = 0.195; 95 %CI:0.054–0.702; P = 0.012; I2 = 0). The clinical success of EUS-GE was statistically similar to SGJ (OR = 1.566; 95 %CI:0.585–4.197; P = 0.372; I2 = 46.68 %). EUS-GE had significantly fewer AEs compared to SGJ (OR = 0.295; 95 %CI:0.172–0.506; P < 0.005; I2 = 0). Among studies which reported reintervention rates, EUS-GE was statistically similar to SGJ (OR = 0.587; 95 %CI:0.174–1.979; P = 0.390, I2 = 54.91). Minimal to moderate heterogeneity was noted in the analyses. Conclusions EUS-GE has equivalent clinical success and reintervention rates, but significantly lower adverse events compared to SGJ. When feasible, EUS-GE appears to be an effective and safe alternative to SGJ for palliative management of malignant GOO.

Palliative therapy for malignant gastric outlet obstruction: how does the endoscopic ultrasound-guided gastroenterostomy compare with surgery and endoscopic stenting? A systematic review and meta-analysis

“…Several trials have compared those methods with somewhat contradictory results. [8][9][10] Moreover, there are numerous meta-analysis, but few evaluate EUS-G. [11][12][13] The ones assessing EUS-G outcomes either excluded ES from evaluation, 14 failed to detect and include eligible studies, or mixed benign with malignant cases. 15 Therefore, we aimed to perform a thorough and strict meta-analysis to compare EUS-G with the SGJJ and ES in treating patients with malignant GOO (MGOO).…”

Endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stents: a retrospective multicentric comparison of wireless and over-the-wire techniques

“…In addition, EUS-GE could also be used as a "temporary" treatment of GOOs of benign origin while healing of the duodenal digestive lumen [12]. A comparable clinical success with less adverse events (AEs) compared to SGE has also been reported in the literature [13][14][15].…”

Endoscopic ultrasound gastroenterostomy: how to avoid inadvertent gastrocolostomy

“…Endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) is a commonly used modality in patients with gastric outlet obstruction, with results equivalent to surgical gastrojejunostomy [1,2]. Inadvertent gastrocolostomy is a rare but major complication of EUS-GE [3].…”