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
Review
. 2020 Jan-Feb;9(1):16-23.
doi: 10.4103/eus.eus_70_19.

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

Umair Iqbal  1 , Harshit S Khara  2 , Yirui Hu  3 , Vikas Kumar  2 , Kashif Tufail  2 , Bradley Confer  2 , David L Diehl  2
Affiliations
Review

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

Umair Iqbal et al. Endosc Ultrasound. 2020 Jan-Feb.

Abstract

Gastric outlet obstruction (GOO) is characterized by epigastric pain and postprandial vomiting secondary to mechanical obstruction. Management of GOO is usually focused on alleviating the symptoms of obstruction and can be achieved by surgical gastrojejunostomy or enteral stenting. Recent studies have shown success with EUS-guided gastroenterostomy (EUS-GE) in the management of GOO but data is limited. We, therefore, conducted a meta-analysis to evaluate the safety and efficacy of EUS-GE in the management of GOO. A comprehensive literature review was conducted by searching the Embase and PubMed databases from inception to January 2019 to identify all studies that evaluate the efficacy and safety of EUS-GE in GOO. Our primary outcome was to evaluate technical success and clinical success. Secondary outcomes were to evaluate the need for reintervention and adverse events of the procedure. Twelve studies including 285 patients were included in the meta-analysis. Technical success was achieved in 266 patients with a pooled technical success of 92% (95% confidence interval [CI]: 88%-95%). Clinical success was achieved in 90% of the patients (95% CI: 85%-94%). Recurrence of symptoms or unplanned reintervention was needed in 9% of the patients (95% CI: 6%-13%) and adverse events were reported in 12% of the patients (95% CI: 8%-16%). The heterogeneity tests among studies were nonsignificant with I2 = 0. EUS-GE is a safe and efficacious treatment modality for the management of benign and malignant GOO. Larger prospective studies are needed to further evaluate its utility in GOO.

Keywords: EUS; enteral stenting; gastric outlet obstruction; gastroenterostomy; gastrojejunostomy.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Literature review process
Figure 2
Figure 2
Forrest plot of all studies for technical success
Figure 3
Figure 3
Forrest plot of all studies for clinical success
Figure 4
Figure 4
Forrest plot of all studies for adverse events
Figure 5
Figure 5
Forrest plot of all studies for recurrence of symptoms or need for re-intervention
Figure 6
Figure 6
Funnel plot diagram to evaluate publication bias
See this image and copyright information in PMC

References

    1. Tendler DA. Malignant gastric outlet obstruction: Bridging another divide. Am J Gastroenterol. 2002;97:4–6. - PubMed
    1. van Heek NT, van Geenen RC, Busch OR, et al. Palliative treatment in “peri”-pancreatic carcinoma: Stenting or surgical therapy? Acta Gastroenterol Belg. 2002;65:171–5. - PubMed
    1. Solt J, Bajor J, Szabó M, et al. Long-term results of balloon catheter dilation for benign gastric outlet stenosis. Endoscopy. 2003;35:490–5. - PubMed
    1. Kochhar R, Dutta U, Sethy PK, et al. Endoscopic balloon dilation in caustic-induced chronic gastric outlet obstruction. Gastrointest Endosc. 2009;69:800–5. - PubMed
    1. Chiu YC, Liang CM, Tam W, et al. The effects of endoscopic-guided balloon dilations in esophageal and gastric strictures caused by corrosive injuries. BMC Gastroenterol. 2013;13:99. - PMC - PubMed