Endoscopic Ultrasound–guided Gastroenterostomy vs Enteral Stenting for Malignant Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis

BACKGROUND AND AIMS

Treatment options for malignant gastric outlet obstruction (GOO) usually rely on surgical gastroenterostomy or endoscopic stenting (ES). The former is more invasive and has a higher rate of adverse events, and the latter is limited by stent patency and has a higher reintervention rate. Endoscopic ultrasound–guided gastroenterostomy (EUS-GE) is a new option that can provide longer stent patency than ES without the invasiveness of surgery. This study aimed to compare the efficacy and safety of EUS-GE vs ES for the treatment of malignant GOO.

METHODS

We performed a systematic review and meta-analysis using the PubMed, Embase, and Cochrane databases. We searched for randomized and nonrandomized matched-control studies comparing EUS-GE with ES in patients with malignant GOO and reporting at least 1 of the outcomes of interest. The primary outcomes assessed were clinical and technical success. The odds ratio was used for binary outcomes and the mean difference for continuous outcomes, with their respective 95% CIs. Heterogeneity was assessed using the Cochran Q test and I² statistics. Trial sequential analysis was performed.

RESULTS

This study included 1 randomized controlled trial and 4 matched-control studies, totaling to 507 patients. There was a statistically significant difference between EUS-GE and ES in the clinical success (odds ratio, 2.81; 95% CI, 1.58-4.99; P < 0.001; I² = 0%). Trial sequential analysis crossed the required information size line for the clinical success outcome.

CONCLUSION

EUS-GE is a reasonable option in the treatment of malignant GOO, mainly in the context of tertiary-care advanced endoscopy centers, with higher clinical success rate. Standardization and wider dissemination of the EUS-GE technique are required to reduce technical challenges.