EUS-guided gastroenterostomy for gastric outlet obstruction: a comprehensive meta-analysis

The Role of Endoscopy in the Palliation of Pancreatico-Biliary Cancers: Biliary Drainage, Management of Gastrointestinal Obstruction, and Role in Relief of Oncologic Pain

“…However, a challenging scenario recently explored was the creation of EUS-GEA for GOO with peritoneal carcinomatosis, which showed slightly better outcomes when compared to SGJ, having comparable technical success (both 100%) and clinical success (88% vs. 85%, p > 0.99), but a lower rate of AEs (8% vs. 41%, p = 0.01, respectively). EUS-GEA is generally a safe technique, showing 12.9% of AEs in a prospective study evaluating 104 patients [94], which was similar to those pooled rates presented in the meta-analyses (13.1%), which was significantly low when compared to SGJ (13.4% vs. 33.3%, p < 0.001) [92,93]. Various comparative studies have been published in order to evaluate which is the most effective treatment for those patients developing mGOO, even if most of them have been retrospective so far.…”

“…Recently, a further and updated meta-analysis including 1493 patients with both benign and malignant GOO treated with EUS-GEA showed technical success and clinical success rates of 94% and 89.9%, respectively. Furthermore, safety analysis showed a pooled rate of AEs of 13.1% [92]. Moreover, a recent multicenter retrospective study evaluated differences in treating mGOO with EUS-GEA (n = 187) vs. surgical gastrojejunostomy (SGJ, n = 123), showing significantly lower time to resumption of oral intake (1.40 vs. 4.06 days, p < 0.001) and a shorter length of stay (5.31 vs. 8.54 days, p < 0.001) comparing EUS-GEA with SGJ, with no differences in technical and clinical success between procedures (97.9% vs. 100% for TS and 94.1% vs. 94.3% for CS, respectively) [93].…”

The Role of Luminal Apposing Metal Stents on the Treatment of Malignant and Benign Gastric Outlet Obstruction

“…On the other hand, EUS-GE showed significantly lower rates of AEs compared with SGJ (OR 0.17, 95% CI 0.10-0.30), which were not significantly different versus enteral stenting alone (OR 0.57, 95% CI 0.29-1.14). These results were replicated by another comprehensive meta-analysis including twenty-six studies with 1493 patients, with the authors concluding that despite being technically challenging, EUS-GE has high technical and clinical success rates comparable with surgical gastroenterostomy, thus representing a very effective, minimally invasive procedure for GOO, once expertise in performing the procedure has been gained [41]. So far, no differences in outcomes of EUS-GE depending on the etiology of malignant GOO have been specifically reported.…”