Comparative efficacy and safety of endoscopic ultrasound-guided gastrojejunostomy versus surgical gastrojejunostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis.

Abstract

Background: Gastric outlet obstruction (GOO) is a common condition leading to impaired gastric emptying and nutritional decline. Surgical gastrojejunostomy (SGJ) has been the traditionally used bypass approach. Endoscopic ultrasound-guided gastrojejunostomy (EUSGJ) has recently emerged as a promising alternative. This systematic review and meta-analysis aimed to compare the efficacy and safety of EUSGJ vs. SGJ for the management of GOO.

Methods: PubMed, Embase, MEDLINE and Cochrane were searched to identify studies that specifically compared outcomes of EUSGJ vs. SGJ in GOO patients. Outcomes assessment focused on procedural metrics and immediate postoperative recovery.

Results: Nine retrospective studies incorporating 1086 patients were included. SGJ was superior in terms of technical success (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.05-0.45; P<0.001). EUSGJ was superior in terms of length of hospital stay (mean difference [MD] -4.79, 95%CI -6.52 to -3.06; P<0.001), overall complications (OR 0.24, 95%CI 0.17-0.33, P<0.001), ileus (OR 0.07, 95%CI 0.02-0.17; P<0.001), operative time (MD -96.89, 95%CI -146.16 to -47.61; P<0.001) and infection (OR 0.17, 95%CI 0.08-0.37; P<0.001). No significant differences were demonstrated in terms of clinical success, reintervention, hemorrhage, and perforation.

Conclusions: EUSGJ is a safe alternative to SGJ for the palliation of GOO in the arsenal of expert endoscopists. Further research is warranted to establish its place in the complex decision-making process around GOO management in the context of individualized patient care.