EUS-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: Systematic review and meta-analysis

Abstract

Abtract Background and study aims Endoscopic and surgical techniques have been utilized for palliation of gastric outlet obstruction (GOO). Enteral stenting (ES) is an established technique with high clinical success and low morbidity rate. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel approach that aims to provide sustained palliation of GOO. We conducted a comprehensive review and meta-analysis to evaluate the effectiveness in terms of clinical and technical success, as well as the safety profile of EUS-GE and ES. Methods We searched multiple databases from inception through July 2020 to identify studies that reported on safety and effectiveness of EUS-GE in comparison to ES. Pooled rates of technical success, clinical success, and adverse events (AEs) were calculated. Study heterogeneity was assessed using I2% and 95 % confidence interval. Results Five studies including 659 patients were included in our final analysis. Pooled rate of technical and clinical success for EUS-GE was 95.2 % (CI 87.2-.98.3, I2 = 42) and 93.3 % (CI 84.4–97.3, I2 = 59) while for ES it was 96.9 % (CI 90.9–99, I2 = 64) and 85.6 % (CI 73–92.9, I2 = 85), respectively. Pooled rate of re-intervention was significantly lower with EUS-GE i. e. 4 % (CI 1.8–8.7, I2 = 35) compared to ES, where it was 23.6 % (CI 17.5–31, I2 = 35), p = 0.001. Pooled rates of overall and major AEs were comparable between the two techniques. Conclusion EUS-GE is comparable in terms of technical and clinical effectiveness and has a similar safety profile when compared to ES for palliation of GOO.

Adverse events associated with EUS and EUS-guided procedures

“…A 2021 metaanalysis of 5 studies assessing 659 patients reported a pooled overall AE rate of 10.7% with EUS-GE, with a major AE rate of 3.7%. 101 A 2020 meta-analysis of 12 studies assessing 285 patients reported a similar pooled overall AE rate of 12%. 102 The most common associated AE is stent maldeployment into the peritoneum resulting in perforation, occurring in up to 6.8% to 10% of procedures.…”

Futuristic Developments and Applications in Endoluminal Stenting

“…When compared to transluminal SEMS placement, EUS-GE have comparable technical and clinical effectiveness. Chandan et al [ 109 ] reported a pooled rate for technical and clinical success of 95.2% and 93.3% in EUS-GE and 96.9% and 85.6% in SEMS. Pooled rate of reintervention was significantly lower with EUS-GE compared to SEMS (4% vs. 23.6%, p = 0.001); however, AEs were comparable between the two techniques.…”

EUS-guided gastroenterostomy versus surgical gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis

“…Studies have demonstrated the feasibility of this technique with high success rates and few adverse events (AEs), as well as long-term durability and a low rate of reintervention 12 15 16 17 18 . Additional studies have found comparable efficacy and safety to endoscopic stenting but with fewer recurrences requiring reintervention 19 20 .…”