Enteral Stent Placement Versus Eus-Guided Gastroenterostomy for Palliation Of Malignant Gastric Outlet Obstruction: a Comparative Systematic Review and Meta-Analysis

Aims Malignant gastric outlet obstruction (GOO) is associated with significant morbidity and decreased quality of life. Therefore, effective palliative treatment is critically important. This the first systematic review and meta-analysis to compare enteral stenting (ES) versus endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for palliation of malignant GOO in terms of efficacy and safety.

Methods Searches were performed on MEDLINE, Central Cochrane, EMBASE, LILACS, and gray literature with no restrictions regarding the year of publication or language, to identify studies comparing ES versus EUS-GE for palliation of malignant GOO. Evaluated outcomes were: technical success, clinical success, length of hospital stay, severe adverse events, stent obstruction, stent obstruction due to tumor growth, symptom recurrence and re-intervention, and 30-day all-cause mortality.

Results Three studies with a total of 242 patients were included. The EUS-GE group demonstrated higher clinical success (RD -0.14, CI -0.25,- 0.03; P = 0.01), less severe adverse events (RD 0.39, CI 0.18–0.82; P = 0.01), lower rates of stent obstruction (RD -0,2, CI -0,29,-0,12; P < 0.00001), stent obstruction due to tumor growth (RD -0,14, CI -0,21,-0,06; P 0.0002), and symptom recurrence and re-intervention (RD -0.20, CI -0.31,-0.08; P = 0.0009). There was no statistical difference between the groups regarding technical success, length of hospital stay, and 30-day all-cause mortality. The results are summarized in [Table 1].

Tab. 1 Synthesis of results for each outcome (EUS-GE x ES).

OUTCOMES	OVERALL ANALYSIS (RESPECTIVELY)
Technical success, and clinical success	RD = 0.01 (95 % CI: -0.06, 0.04; P = 0.68); RD = 0.14, (95 % CI -0.25,- 0.03; P = 0.01)
Length of hospital stay, and severe adverse events	RD = 1.42 (95 % CI: -0.31; 3.14; P = 0.11;); RD = 0.39, (95 % CI 0.18–0.82; P = 0.01)
Stent obstruction, and stent obstruction due to tumor growth	RD = -0,20, (95 % CI -0,29,-0,12; P = < 0.00001); RD = -0,14, (95 % CI -0,21,-0,06; P = 0.0002)
Symptom recurrence and re-intervention, and 30-day all-cause mortality	RD = -0.20, (95 % CI -0.31,-0.08; P = 0.0009); RD = 0.22, (95 % CI 0.03, 1.71; P = 0.15)

Conclusions EUS-GE is superior to ES for malignant GOO palliation regarding clinical success, symptom recurrence and re-intervention, severe adverse events, stent obstruction, and stent obstruction due to tumor growth.

Citation: Boghossian MB, Funari MP, de Moura DTH et al. OP109 ENTERAL STENT PLACEMENT VERSUS EUS-GUIDED GASTROENTEROSTOMY FOR PALLIATION OF MALIGNANT GASTRIC OUTLET OBSTRUCTION: A COMPARATIVE SYSTEMATIC REVIEW AND META-ANALYSIS. Endoscopy 2021; 53: S46.

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Artikel online veröffentlicht:
19. März 2021