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

Abstract

Background and study aims Surgical gastroenterostomy (SGE) has been the mainstay treatment for gastric outlet obstruction (GOO). The emergence of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) presents a less invasive alternative for palliation of GOO. We conducted a comprehensive review and meta-analysis to compare the effectiveness and safety of EUS-GE compared to SGE. Methods Multiple electronic databases and conference proceedings up to April 2021 were searched to identify studies that reported on safety and effectiveness of EUS-GE in comparison to SGE. Pooled odds ratios (ORs) of technical success, clinical success, adverse events (AE) and recurrence, and pooled standardized mean difference (SMD) of procedure time and post-procedure length of stay (LOS) were calculated. Study heterogeneity was assessed using I 2 and Cochran Q statistics. Results Seven studies including 625 patients (372 EUS-GE and 253 SGE) were included. EUS-GE had lower pooled odds of technical success compared with SGE (OR 0.19, 95 % confidence interval [CI] 0.06–0.60, I 2 0 %). Among the technically successful cases, EUS-GE was superior in terms of clinical success (OR 4.73, 95 % CI 1.83–12.25, I 2 18 %), lower overall AE (OR 0.20, 95 % CI 0.10–0.37, I 2 39 %), and shorter procedure time (SMD –2.4, 95 % CI –4.1, –0.75, I 2 95 %) and post-procedure LOS (SMD –0.49, 95 % CI –0.94, –0.03, I 2 78%). Rates of severe AE (0.89, 95 % CI 0.11–7.36, I 2 67 %) and recurrence (OR 0.49, 95 % CI 0.18–1.38, I 2 49 %) were comparable. Conclusions Our results suggest EUS-GE is a promising alternative to SGE due to its superior clinical success, overall safety, and efficiency. With further evolution EUS-GE could become the intervention of choice in GOO.

Endoscopic ultrasound‐guided gastrointestinal anastomosis: Current status and future perspectives

“…The most recent systematic review comparing EUS-GE with SGE (seven studies, n = 625 patients) showed lower (pooled odds of) technical success for EUS-GE, albeit with higher per-protocol clinical success, lower overall AEs, and shorter hospital stay. 29 As for comparisons with enteral or duodenal stenting in malignant GOO, three studies have been published to date. 5,25,30 The most recent study by the Leuven-Amsterdam-Milan Study (LAMS)-group compared 176 propensity score-matched patients undergoing either EUS-GE or enteral stenting with uncovered self-expandable metal stents (SEMS).…”

“…Besides technical aspects of EUS-GE, also more data on comparisons with surgical gastroenterostomy (SGE) and enteral stenting have been emerging (Table 1). The most recent systematic review comparing EUS-GE with SGE (7 studies, n=625 patients), showed lower (pooled odds of) technical success for EUS-GE, albeit with higher per-protocol clinical success, lower overall AE and shorter hospital stay 31 . As for comparisons with enteral or duodenal stenting in malignant GOO, three studies have been published to date 5,27,32 .…”

How to successfully administer palliative treatment with a stent for malignant gastric outlet obstruction?

“…A meta-analysis that compared EUS-GJ with enteral stenting reported comparable success rates and lower rates of reintervention in EUS-GJ (4 vs. 23.6%, P = 0.001) ( 62 ). A meta-analysis that compared EUS-GJ with SGJ showed that EUS-GJ was superior in terms of clinical success, lower overall AE, shorter procedure time, and shorter post-procedure hospital stay ( 63 ). Although there are no officially approved dedicated devices for EUS-GJ in some countries, and the procedure requires experienced hands, it will be necessary to create a treatment decision algorithm that also includes EUS-GJ based on the patient's condition in the future.…”

Current status of, and challenges posed by, endoscopic ultrasound‐guided anastomosis of the digestive tract in patients with afferent loop syndrome

“…2 Two independent meta-analyses compared EUS-GJ and surgical GJ for GOO; EUS-GJ exhibited a lower technical success rate than surgical GJ, but similar clinical success and reintervention rates; EUS-GJ was associated with fewer complications. 3,4 Only a few reports of EUS-guided anastomosis (EUS-A) for patients with ALS have appeared. 5 6 and LAMSs in 2015, 7 respectively; efficacy and safety are still under investigation.…”

“…In a systematic review of 12 studies and 285 cases, the technical success rate was 92% (95% confidence interval [CI] 88–95), while the clinical success rate was 90% (95% CI 85–94), the symptom recurrence rate was 9% (95% CI 6–13), and the adverse event rate was 12% (95% CI 8–16) 2 . Two independent meta‐analyses compared EUS‐GJ and surgical GJ for GOO; EUS‐GJ exhibited a lower technical success rate than surgical GJ, but similar clinical success and reintervention rates; EUS‐GJ was associated with fewer complications 3,4 …”