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Review
. 2022 Apr 14;10(4):E448-E458.
doi: 10.1055/a-1765-4035. eCollection 2022 Apr.

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

Anand Kumar  1   2 , Saurabh Chandan  3 , Babu P Mohan  4 , Pradeep R Atla  5 , Evin J McCabe  1   2 , David H Robbins  1   2 , Arvind J Trindade  2   6 , Petros C Benias  1   2   6
Affiliations
Review

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

Anand Kumar et al. Endosc Int Open. .

Abstract

Background and study aims Surgical gastroenterostomy (SGE) has been the mainstay treatment for gastric outlet obstruction (GOO). The emergence of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) presents a less invasive alternative for palliation of GOO. We conducted a comprehensive review and meta-analysis to compare the effectiveness and safety of EUS-GE compared to SGE. Methods Multiple electronic databases and conference proceedings up to April 2021 were searched to identify studies that reported on safety and effectiveness of EUS-GE in comparison to SGE. Pooled odds ratios (ORs) of technical success, clinical success, adverse events (AE) and recurrence, and pooled standardized mean difference (SMD) of procedure time and post-procedure length of stay (LOS) were calculated. Study heterogeneity was assessed using I 2 and Cochran Q statistics. Results Seven studies including 625 patients (372 EUS-GE and 253 SGE) were included. EUS-GE had lower pooled odds of technical success compared with SGE (OR 0.19, 95 % confidence interval [CI] 0.06-0.60, I 2 0 %). Among the technically successful cases, EUS-GE was superior in terms of clinical success (OR 4.73, 95 % CI 1.83-12.25, I 2 18 %), lower overall AE (OR 0.20, 95 % CI 0.10-0.37, I 2 39 %), and shorter procedure time (SMD -2.4, 95 % CI -4.1, -0.75, I 2 95 %) and post-procedure LOS (SMD -0.49, 95 % CI -0.94, -0.03, I 2 78%). Rates of severe AE (0.89, 95 % CI 0.11-7.36, I 2 67 %) and recurrence (OR 0.49, 95 % CI 0.18-1.38, I 2 49 %) were comparable. Conclusions Our results suggest EUS-GE is a promising alternative to SGE due to its superior clinical success, overall safety, and efficiency. With further evolution EUS-GE could become the intervention of choice in GOO.

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Conflict of interest statement

Competing interests Dr. Trindade is a consultant to Pentax Medical and Olympus America and receives research support from NinePoint Medical. Dr. Benias is a consultant for Olympus America, Apollo Endosurgery, Boston Scientific, and FujiFilm.

Figures

Fig. 1
Fig. 1
Forest Plots of primary outcomes: technical Success, clinical success, all adverse events, recurrence.
Fig. 2
Fig. 2
Forest Plots of severe adverse events, procedure time, and post-procedure length of stay.
See this image and copyright information in PMC

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