Clinical outcomes of endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a systematic review and meta-analysis

Abstract

Background and aims

EUS-guided gastroenterostomy (EUS-GE) has been used for gastric outlet obstruction (GOO) with promising clinical outcomes. Therefore, we aimed to determine the clinical outcomes of EUS-GE for GOO.

Material and methods

We used the keyword ‘EUS-guided gastroenterostomy’ to search in Pubmed, Web of science, Cochrane databases. Clinical outcomes of EUS-GE were evaluated in terms of technical success, clinical success and complications.

Results

Ten studies reported 297 patients managed with EUS-GE. Weighted pooled rates (WPR) for technical success, clinical success and complications of EUS-GE were 91% (95%CI 87%-94%), 88% (95%CI 83%–91%) and 6.8% (95%CI 4.1%–11.0%). The most common complications were abdominal pain, 6.7% (95%CI 2.5%–16.5%) and bleeding, 4.8% (95%CI 1.5%–13.9%). Two studies compared EUS-GE with surgical gastrojejunostomy (SGJ). Pooled risk ratio (RR) for technical success, clinical success and complications were 0.87 (0.78, 0.97), I² = 0%; 0.92 (0.82, 1.04), I² = 0%; 0.28 (0.11, 0.68), I² = 0%. Three studies compared benign GOO with malignant GOO. RR for technical success and clinical success were 1.05 (0.82, 1.34), I² = 0%; 0.98 (0.72, 1.33), I² = 0%.

Conclusions

Although EUS-GE and SGJ had similar clinical success rates, EUS-GE had a lower complication rate. EUS-GE is a safe, effective, and minimally invasive choice for patients with GOO.

Keywords:

• Endoscopic ultrasound-guided gastroenterostomy
• gastric outlet obstruction
• surgical gastrojejunostomy

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This study is independent research funded by the following grants: Medical science and technology plan projects of Zhejiang Province (No. 2017196257), Youth Foundation of Southwest Medical University (No. 0903-00031099), Doctoral research start-up funding project of Affiliated Hospital of Southwest Medical University (No. 16229).