Adverse events with endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction-A systematic review and meta-analysis

Abstract

Background: The technical and clinical effectiveness of endoscopic ultrasonography (EUS)-guided gastroenterostomy (GE) has been reported by several meta-analyses, but few of them have addressed the adverse events (AE). The goal of the current meta-analysis was to analyze the AEs associated with various types of EUS-GE.

Methods: All relevant studies reporting the AEs with EUS-GE were searched from 2000 to 31st March 2023 in MEDLINE, Embase, and Scopus. The event rates were pooled using a random effects model.

Results: A total of 36 studies (n = 1846) were included in the meta-analysis. The present meta-analysis reports a pooled technical success rate of 96.9% (95.9-98.0; I² = 29.3%) with a pooled clinical success rate of 90.6% (88.5-92.7; I² = 60.9%). The pooled incidence of overall AEs with EUS-GE was 13.0% (10.3-15.7; I² = 69.7%), with the commonest being maldeployment of the stent, seen in 4.6% (3.2-6.0; I² = 50.6%). The pooled incidences of serious AE and procedure-related mortality were 1.2% (0.7-1.8; I² = 1.9%) and 0.3% (0.0-0.7; I² = 0.0%), respectively. Subgroup analysis of studies using only the free-hand technique showed a significantly lower overall AE and maldeployment but not serious AE and other individual AEs. The pooled incidences of delayed stent migration and stent occlusion were 0.5% (0.0-1.1; I² = 0.0%) and 0.8% (0.2-1.3; I² = 0.0%), respectively.

Conclusion: Despite a technical and clinical success rate of >90%, AEs are seen in around one-seventh of the cases of EUS-GE, maldeployment being the commonest. However, the pooled incidence of serious AE and mortality remains low, which is reassuring.

Keywords: endoscopic ultrasound; gastric outlet obstruction; gastroenterostomy; gastrojejunostomy; meta‐analysis.

FIGURE 1

Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flowchart for study identification, screening, and inclusion process.

FIGURE 2

Forest plot showing the pooled proportion of adverse events with endoscopic ultrasound‐guided gastrojejunostomy with subgroup analysis based on the type of procedure (Studies using only free‐hand technique vs. other techniques).

FIGURE 3

Meta‐regression analysis showing the publication year as a significant covariate contributing to heterogeneity with respect to (a) overall adverse events and (b) maldeployment.