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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E448-E458
DOI: 10.1055/a-1765-4035
Review

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

Anand Kumar
1   Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
,
Saurabh Chandan
3   Division of Gastroenterology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Babu P. Mohan
4   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Pradeep R. Atla
5   Palmdale Regional Medical Center, Palmdale, California, United States
,
Evin J. McCabe
1   Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
,
David H. Robbins
1   Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
,
Arvind J. Trindade
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
6   Division of Gastroenterology, North Shore University Hospital, Manhasset, New York, United States
,
Petros C. Benias
1   Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
6   Division of Gastroenterology, North Shore University Hospital, Manhasset, New York, United States
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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.

Supplementary material



Publication History

Received: 20 July 2021

Accepted after revision: 25 October 2021

Article published online:
14 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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