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

Abstract

Introduction: The gold-standard procedure to address malignant gastric outlet obstruction (MGOO) is surgical gastrojejunostomy (SGJJ). Two endoscopic alternatives have also been proposed: the endoscopic stenting (ES) and the endoscopic ultrasound-guided gastroenterostomy (EUS-G). This study aimed to perform a thorough and strict meta-analysis to compare EUS-G with the SGJJ and ES in treating patients with MGOO. Materials and Methods: Studies comparing EUS-G to endoscopic stenting or SGJJ for patients with MGOO were considered eligible. We conducted online searches in primary databases (MEDLINE, EMBASE, Lilacs, and Central Cochrane) from inception through October 2021. The outcomes were technical and clinical success rates, serious adverse events (SAEs), reintervention due to obstruction, length of hospital stay (LOS), and time to oral intake. Results: We found similar technical success rates between ES and EUS-G but clinical success rates favored the latter. The comparison between EUS-G and SGJJ demonstrated better technical success rates in favor of the surgical approach but similar clinical success rates. EUS-G shortens the LOS by 2.8 days compared with ES and 5.8 days compared with SGJJ. Concerning reintervention due to obstruction, we found similar rates for EUS-G and SGJJ but considerably higher rates for ES compared with EUS-G. As to AEs, we demonstrated equivalent rates comparing EUS-G and SGJJ but significantly higher ones compared with ES. Conclusion: Despite being novel and still under refinement, the EUS-G has good safety and efficacy profiles compared with SGJJ and ES.

Revealing Insights: A Comprehensive Overview of Gastric Outlet Obstruction Management, with Special Emphasis on EUS-Guided Gastroenterostomy

“…In their retrospective study, Jaruvongvanich et al also showed that in a median observation duration of 185.5 days, EUS-GE in comparison with SGE was related with significantly increased clinical success rate (98.3% vs. 90.4%, p = 0.002), significantly lower reintervention rate for recurrent GOO (0.9%, and 13.7%, respectively, p < 0.0001) and lower adverse effects rate, indicating that EUS-GE could secure long-term patency and clinical improvement equally to SGE [36]. Furthermore, EUS-GE compared to SGE required a shorter post-procedure length of hospital stay (MD: -5.95; 95% CI: -6.99 to -4.91; p < 0.001; I2 = 95%) and led to faster return to both oral consumption and chemotherapy in cases of mGOO [35,37]. This is of great importance since these patients often have unresectable tumors and palliative chemotherapy is the only available therapy to improve their prognosis.…”