EUS-GUIDED GASTROENTEROSTOMY TECHNIQUES FOR PALLIATION OF MALIGNANT GASTRIC OUTLET OBSTRUCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Aims Malignant gastric outlet obstruction(GOO) is usually associated with poor prognosis and an important decrease in the quality of life. Ultrasound-guided endoscopic gastroenterostomy(EUS-GE) has emerged as a safe and effective palliation procedure for GOO. We aimed to compare the currently available techniques in this systematic review with meta-analysis.

Methods A comprehensive search of multiple electronic databases was performed to identify all the studies in which EUS-GE was performed in a form of palliation for GOO with emphasis on the used techniques. The outcomes analyzed were: technical and clinical success, total and severe adverse events(AE), procedure duration, and length of hospital stay(LOHS).

Results Fifteen studies (690 patients) were included in the statistical analysis. Patients were divided into a direct puncture(DGE, n=496), balloon-assisted gastroenterostomy (BAGE, n=27), and EUS-guided double-balloon-occluded gastrojejunostomy bypass(EPASS, n=67) subgroups. When DGE was compared to the balloon-assisted techniques (BTGE) we found a statistically significant lower LOHS of 1.7 days(95% CI 0,012 to 3,578,I²=59%, p=0,048). No statistically significant differences in clinical and technical success, total and severe AE, and procedure duration were found in our analysis between DGE and BTGE. Finally, no statistically significant differences were found when comparing BAGE and EPASS in any of the aforementioned outcomes.

Conclusions EUS-GE is safe and effective treatment for the palliation of GOO. Any of the analyzed techniques may be used to palliate malignant GOO with similar technical and clinical outcomes. DGE was associated with a lower length of hospitalization. Further well-designed randomized clinical studies are warranted to compare the different techniques.

Publication History

Article published online:
14 April 2022