Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov;7(11):E1474-E1482.
doi: 10.1055/a-0996-8178. Epub 2019 Oct 23.

Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis

Thomas R McCarty  1   2 , Rajat Garg  3 , Christopher C Thompson  1   2 , Tarun Rustagi  4
Affiliations

Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis

Thomas R McCarty et al. Endosc Int Open. 2019 Nov.

Abstract

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel endoscopic procedure designed to facilitate sustained luminal patency in patients with gastric outlet obstruction. The primary aim of this study was to evaluate the efficacy and safety of EUS-GE for treatment of gastric outlet obstruction. Methods Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed through April 2019. Patients with benign and malignant gastric outlet obstruction were included. Measured outcomes included: immediate technical and clinical success as well as rate of serious adverse events (AEs). Heterogeneity was assessed with Cochran Q test and I 2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. Results A total of five studies (n = 199 patients; 45.73 % male) were included in this study. Four retrospective studies and one prospective study were analyzed. Mean age of patients that underwent the EUS-GE procedure was 64.52 ± 1.37 years with a pooled mean follow-up period of 4.32 ± 1.65 months. In 21 % of patients (n = 43), gastric outlet obstruction was due to benign causes. Immediate technical success was 92.90 % (95 % CI; 88.26 - 95.79; I 2 = 0.00 %) and reported in all studies. The clinical success rate of EUS-GE was 90.11 % (95 % CI; 84.64 - 93.44; I 2 = 0.00 %). Serious AEs occurred in 5.61 % (95 % CI; 2.87 - 10.67; I 2 = 1.67 %) of cases and were related to peritonitis, perforation, bleeding, and abdominal pain. Re-intervention rate was 11.43 % (95 % CI; 7.29 - 17.46; I 2 = 17.38 %). Conclusions EUS-GE appears to provide an effective and safe minimally invasive alternative for treatment of benign and malignant gastric outlet obstruction.

PubMed Disclaimer

Conflict of interest statement

Competing interests Dr. Thompson is a consultant for Boston Scientific, Olympus, and Apollo Endosurgery. Dr. Rustagi is a consultant for Boston Scientific and Cook Endoscopy.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart of literature search results for EUS-guided gastroenterostomy for the treatment of gastric outlet obstruction.
Fig. 2 a
Fig. 2 a
Immediate success rate for EUS-guided gastroenterostomy for the treatment of gastric outlet obstruction. b Clinical success rate for EUS-guided gastroenterostomy for the treatment of gastric outlet obstruction.
Fig. 3 a
Fig. 3 a
Serious adverse events for EUS-guided gastroenterostomy for the treatment of gastric outlet obstruction. b Repeat interventions required after EUS-guided gastroenterostomy for the treatment of gastric outlet obstruction.
Fig. 4
Fig. 4
Funnel plot of publication bias and Eggers regression test for included studies to assess EUS-guided gastroenterostomy for the treatment of gastric outlet obstruction.
See this image and copyright information in PMC

References

    1. Chowdhury A, Dhali G K, Banerjee P K. Etiology of gastric outlet obstruction. Am J Gastroenterol. 1996;91:1679. - PubMed
    1. Johnson C D. Gastric outlet obstruction malignant until proved otherwise. Am J Gastroenterol. 1995;90:1740. - PubMed
    1. Johnson C D, Ellis H. Gastric outlet obstruction now predicts malignancy. Br J Surg. 1990;77:1023–1024. - PubMed
    1. Shone D N, Nikoomanesh P, Smith-Meek M M et al. Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. Am J Gastroenterol. 1995;90:1769–1770. - PubMed
    1. Storm A C, Ryou M. Advances in the endoscopic management of gastric outflow disorders. Curr Opin Gastroenterol. 2017;33:455–460. - PubMed