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

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 1 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, P 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.