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

Anand Kumar; Saurabh Chandan; Babu P. Mohan; Pradeep R. Atla; Evin J. McCabe; David H. Robbins; Arvind J. Trindade; Petros C. Benias

doi:10.1055/a-1765-4035

Endoscopy International Open, Inhaltsverzeichnis

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

Autor*innen

Anand Kumar

¹Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States

²Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
Saurabh Chandan

³Division of Gastroenterology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
Babu P. Mohan

⁴Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
Pradeep R. Atla

⁵Palmdale Regional Medical Center, Palmdale, California, United States
Evin J. McCabe

¹Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States

²Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
David H. Robbins

¹Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States

²Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
Arvind J. Trindade

²Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States

⁶Division of Gastroenterology, North Shore University Hospital, Manhasset, New York, United States
Petros C. Benias

¹Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States

²Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States

⁶Division of Gastroenterology, North Shore University Hospital, Manhasset, New York, United States

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.

Volltext

Referenzen

References
1 Chowdhury A, Dhali GK, Banerjee PK. Etiology of gastric outlet obstruction. Am J Gastroenterol 1996; 91: 1679
2 Johnson CD. Gastric outlet obstruction malignant until proved otherwise. Am J Gastroenterol 1995; 90: 1740
3 Takeno A, Takiguchi S, Fujita J. et al. Clinical outcome and indications for palliative gastrojejunostomy in unresectable advanced gastric cancer: multi-institutional retrospective analysis. Ann Surg Oncol 2013; 20: 3527-3533
4 Bahra M, Jacob D. Surgical palliation of advanced pancreatic cancer. Recent Results Cancer Res 2008; 177: 111-120
5 Khashab M, Alawad AS, Shin EJ. et al. Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 2013; 27: 2068-2075
6 Jeurnink SM, Steyerberg EW, van Hooft JE. et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71: 490-499
7 Storm AC, Ryou M. Advances in the endoscopic management of gastric outflow disorders. Curr Opin Gastroenterol 2017; 33: 455-460
8 No JH, Kim SW, Lim CH. et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc 2013; 78: 55-62
9 Itoi T, Baron TH, Khashab MA. et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc 2017; 29: 495-502
10 Khashab MA, Baron TH, Binmoeller KF. et al. EUS-guided gastroenterostomy: a new promising technique in evolution. Gastrointest Endosc 2015; 81: 1234-1236
11 Binmoeller KF, Shah JN. Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study. Endoscopy 2012; 44: 499-503
12 Tyberg A, Perez-Miranda M, Sanchez-Ocana R. et al. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 2016; 4: E276-E281
13 Irani S, Baron TH, Itoi T. et al. Endoscopic gastroenterostomy: techniques and review. Curr Opin Gastroenterol 2017; 33: 320-329
14 Carbajo AY, Kahaleh M, Tyberg A. Clinical review of EUS-guided gastroenterostomy (EUS-GE). J Clin Gastroenterol 2020; 54: 1-7
15 Kerdsirichairat T, Irani S, Yang J. et al. Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction. Endosc Int Open 2019; 7: E144-E50
16 Iqbal U, Khara HS, Hu Y. et al. EUS-guided gastroenterostomy for the management of gastric outlet obstruction: A systematic review and meta-analysis. Endosc Ultrasound 2020; 9: 16-23
17 Itoi T, Ishii K, Ikeuchi N. et al. Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction. Gut 2016; 65: 193-195
18 Khashab MA, Kumbhari V, Grimm IS. et al. EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc 2015; 82: 932-938
19 Chen YI, Itoi T, Baron TH. et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 2017; 31: 2946-2952
20 Chandan S, Khan SR, Mohan BP. et al. EUS-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: Systematic review and meta-analysis. Endosc Int Open 2021; 9: E496-E504
21 Itoi T, Itokawa F, Uraoka T. et al. Novel EUS-guided gastrojejunostomy technique using a new double-balloon enteric tube and lumen-apposing metal stent (with videos). Gastrointest Endosc 2013; 78: 934-939
22 Bondi G, Bazarbashi AN, Abbas AM. et al. Su1269 Endoscopic gastroenterostomy versus surgical gastrojejunostomy for the treatment of gastric outlet obstruction in patients with peritoneal carcinomatosis: a retrospective comparative study. Gastrointest Endosc 2020; 91: AB303
23 Widmer JL, Winner M, Allendorf J. et al. Su1154 Single center comparative study of endoscopic gastrojejunostomy versus surgical gastrojejunostomy for malignant gastric outlet obstruction. Gastrointest Endosc 2019; 89: AB291
24 Marya N, Jaruvongvanich V, Abu Dayyeh BK. et al. Su1268 A multicenter international study comparing clinical outcomes of eus-guided gastrojejunostomy, surgical gastrojejunostomy, and enteral stenting for patients with gastric outlet obstruction. Gastrointest Endosc 2020; 91: AB302-AB303
25 Khashab MA, Bukhari M, Baron TH. et al. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open 2017; 5: E275-E81
26 Perez-Miranda M, Tyberg A, Poletto D. et al. EUS-guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. J Clin Gastroenterol 2017; 51: 896-899
27 Kouanda A, Binmoeller K, Hamerski C. et al. Endoscopic ultrasound-guided gastroenterostomy versus open surgical gastrojejunostomy: clinical outcomes and cost effectiveness analysis. Surg Endosc 2021; 35: 7058-7067
28 Bronswijk M, Vanella G, van Malenstein H. et al. Laparoscopic versus EUS-guided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score-matched comparison (with video). Gastrointest Endosc 2021; 94: 526-536.e2
29 Moher D, Liberati A, Tetzlaff J. et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009; 6: e1000097
30 Stroup DF, Berlin JA, Morton SC. et al. for the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group. Meta-analysis of Observational Studies in Epidemiology. A Proposal for Reporting. . JAMA 2000; 283: 2008-2012
31 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
32 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
33 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
34 Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 2009; 172: 137-159
35 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
36 Wan X, Wang W, Liu J. et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14: 135
37 Higgins JP, White IR, Wood AM. Imputation methods for missing outcome data in meta-analysis of clinical trials. Clin Trials 2008; 5: 225-239
38 Furukawa TA, Barbui C, Cipriani A. et al. Imputing missing standard deviations in meta-analyses can provide accurate results. J Clin Epidemiol 2006; 59: 7-10
39 Higgins JPT, Thomas J, Chandler J. et al. Cochrane Handbook for Systematic Reviews of Interventions. 2 ed. Chichester (UK): John Wiley & Sons; 2019
40 Bronswijk M, Vanella G, Van Malenstein H. et al. VDM. Laparoscopic or EUS-guided gastroenterostomy for gastric outlet obstruction: A propensity score matched analysis. United Europ Gastroenterol J 2020; 8: 804-805
41 Xu G, Shen Y, Lv Y. et al. Safety and efficacy of endoscopic ultrasound-guided gastroenterostomy using double balloon occlusion methods: a clinical retrospective study in 36 patients with malignant gastric outlet obstruction. Endosc Int Open 2020; 8: E1690-E1697
42 Kastelijn JB, Moons LMG, Garcia-Alonso FJ. et al. Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction. Endosc Int Open 2020; 8: E1194-E201
43 Amateau SK, Lim CH, McDonald NM. et al. EUS-guided endoscopic gastrointestinal anastomosis with lumen-apposing metal stent: feasibility, safety, and efficacy. Obes Surg 2018; 28: 1445-1451
44 Kerdsirichairat T, Yang J, Gutierrez OIB. et al. Long-term outcomes of endoscopic ultrasound-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction: A 4-year cohort. Gastrointest Endosc 2018; 87: AB320-AB1
45 Ge PS, Young JY, Dong W. et al. EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction. Surg Endosc 2019; 33: 3404-3411
46 Iqbal U, Berger A, Confer B. et al. Endoscopic ultrasound-guided gastroenterostomy vs. enteral stenting for treatment of gastric outlet obstruction: a retrospective review: 918. Am J Gastroenterol 2019; 114: S536-S537
47 Vazquez-Sequeiros E, Sanchez-Aldehuelo R, de Santiago ER. et al. Su1286 Endoscopic ultrasound-guided gastrojejunostomy is superior to duodenal self expandable metal stent for pallitaive treatment of malignant gastric outlet obstructtion: a comparative case control study. Gastrointest Endosc 2020; 91: AB312-AB313
48 Larghi A, Ibrahim M, Fuccio L. et al. Forward-viewing echoendoscope versus standard echoendoscope for endoscopic ultrasound-guided tissue acquisition of solid lesions: a randomized, multicenter study. Endoscopy 2019; 515: 444-451

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