What is the benefit of endoscopic ultrasound-guided gastrojejunal anastomosis for patients with benign gastric outlet obstruction? A systematic review with meta-analysis

Abstract

Background: Gastric outlet obstruction for benign indications (bGOO) is an uncommon condition, typically treated with surgery when medical therapy or endoscopic treatments fail. At present, endoscopic ultrasound (EUS)-guided gastrojejunostomy (GJ) may prove to be an effective alternative.

Aims: We performed a systematic review with meta-analysis evaluating outcomes of EUS-GJ for bGOO.

Methods: A comprehensive search was conducted up to February 2025. Pooled estimates were obtained using a random-effects model. Study quality was evaluated using the Newcastle-Ottawa quality scale. Heterogeneity was evaluated with I² statistic. Technical success, clinical success, recurrence rate, and adverse events (AE) rate were the main outcomes.

Results: Fifteen (15) studies, including a total of 376 patients, were identified. Pooled technical success was 95.8 % (CI 95 %, 93.8 %-97.8 %, I² =0 %), while clinical success was 93.4 % (CI 95 %, 90.4 %-96.5 %, I²= 31.83 %). Pooled recurrence rate was 11.6 % (CI 95 %, 5.5 %-17.7 %, I2=32.36 %). The pooled rate of AE was 11.6 % (CI 95 %, 6.8-16.5 %, I² = 57.18 %). Subgroup analyses found differences in safety when AE classification was used (17 % use vs. 6 % no use, p = 0.02) and based on quality of studies (low 22 % vs. moderate 10 % vs. high 3 %, p = 0.04).

Conclusion: In conclusion, our findings show that EUS-GJ is effective and safe in those patients with bGOO in whom other endoscopic treatments fail, and surgery is not an option or could be performed as bridge-to-surgery. Our results suggest that safety is influenced by the use of AE classification and the quality of studies.

Keywords: Benign; EUS; EUS-GJ; Endoscopic ultrasound; Endoscopy; GOO; Gastric outlet obstruction; Gastroenterostomy; Gastrojejunostomy; bGOO.