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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(07): E660-E672
DOI: 10.1055/a-2098-2570
Review

EUS-guided gastroenterostomy vs. surgical gastrojejunostomy and enteral stenting for malignant gastric outlet obstruction: a meta-analysis

Corey Miller
1   Division of Gastroenterology, Department of Medicine, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
2   Division of Experimental Medicine, Department of Medicine, McGill University Faculty of Medicine and Health Sciences, Montreal, Canada (Ringgold ID: RIN12367)
,
Joshua A Benchaya
3   Faculty of Medicine, McGill University, Montreal, Canada (Ringgold ID: RIN5620)
1   Division of Gastroenterology, Department of Medicine, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
,
Myriam Martel
4   Research Institute of the McGill University Health Center, McGill University Health Centre, Montreal, Canada (Ringgold ID: RIN54473)
,
Alan Barkun
5   Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada (Ringgold ID: RIN54473)
,
Jonathan M Wyse
1   Division of Gastroenterology, Department of Medicine, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
,
Lorenzo Ferri
6   Surgery, McGill University Health Centre, Montreal, Canada (Ringgold ID: RIN54473)
,
Yen-I Chen
5   Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada (Ringgold ID: RIN54473)
2   Division of Experimental Medicine, Department of Medicine, McGill University Faculty of Medicine and Health Sciences, Montreal, Canada (Ringgold ID: RIN12367)
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Abstract

Background and study aims Malignant gastric outlet obstruction (MGOO) is traditionally treated with surgical gastrojejunostomy (SGJ), which is effective but associated with high rates of morbidity, or endoscopic stenting (ES), which is less invasive but associated with significant risk of stent dysfunction and need for reintervention. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) provides a robust bypass without the invasiveness of surgery.

Methods We performed a systematic review and meta-analysis comparing EUS-GE to SGJ and ES for MGOO. Electronic databases were searched from inception through February 2022. A meta-analysis was performed with results reported as odds ratios (ORs) with 95% confidence intervals (CIs) using random effects models. Primary outcomes included clinical success without recurrent GOO and adverse events (AEs).

Results Sixteen studies involving 1541 patients were included. EUS-GE was associated with higher clinical success without recurrent GOO compared to ES or SGJ [OR 2.60, 95% CI1.58–4.28] and compared to ES alone [OR 5.08, 95% CI 3.42–7.55], but yielded no significant difference compared to SGJ alone [OR 1.94, 95% CI 0.97–3.88]. AE rates were significantly lower for EUS-GE compared to ES or SGJ grouped together [OR 0.34, 95% CI 0.20–0.58], or SGJ alone [OR 0.17, 95% CI 0.10–0.30] but were not significant different versus ES alone [OR 0.57, 95% CI 0.29–1.14].

Conclusions EUS-GE is the most successful approach to treating MGOO, exhibiting a lower risk of recurrent obstruction compared to ES, and fewer AEs compared to SGJ.

Supporting information



Publication History

Received: 09 December 2022

Accepted after revision: 21 April 2023

Accepted Manuscript online:
23 May 2023

Article published online:
26 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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