Efficacy of Endoscopic Ultrasonography Guided Gastroenterostomy in Gastric Outlet Obstruction

Mentor: Amaninder Dhaliwal Program: Internal Medicine Introduction: Gastric outlet obstruction (GOO) is the complication of benign and malignant diseases. Laproscopic gastrojejunostomy and enteral stenting has been the standard of care. Endoscopic ultrasonography guided gastroenterostomy (EUS-GE) has emerged as a newer technique in patients with GOO. Thus, we conducted systematic review and meta-analysis to report the overall technical success, clinical success and adverse events. Methods: Multiple electronic databases (MEDLINE, EMBASE and Google Scholar) and conference abstracts were comprehensively searched to identify studies reporting EUS-GE in patients with GOO. References from identified studies were then manually searched for any additional studies. Primary outcome of our meta-analysis was to see the overall pooled technical and clinical success of the procedure. Secondary outcome was to look at the total adverse events of the procedure. The meta-analysis was performed using Der Simonian and Laird random effect model. Results: 10 studies were included in the final meta-analysis reporting a total of 263 patients (males 135 and females 128) with median age of 61.2 years. The median follow up was 110 days. Overall pooled technical and clinical success rates of the procedure were 92.4% (95% CI= 89–95, I2=0) and 88.5% (95%CI= 84.5–92.5, I2 =0). The total adverse events were 8.1% (95%CI= 4.1–11.9, I2 =23%) mainly as stent migration (n=2) and peritoneal stent deployment (n=15). Conclusion: EUS-GE is a safe and effective technique in patients with GOO with overall high technical and clinical success rates (92.4%, 88.5% respectively). However, further randomized control trials are needed to validate these findings.