Efficacy of Endoscopic Ultrasonography-Guided Gastroenterostomy (EUS-GE) in Gastric Outlet Obstruction (GOO): A Systematic Review and Meta-Analysis

Introduction: Gastric outlet obstruction (GOO) is a sequela of several benign and malignant diseases. Laparoscopic gastrojejunostomy or enteral stenting have been the two common options in standard management algorithm of GOO. Endoscopic ultrasonography guided gastroenterostomy (EUS-GE) is emerging as an alternative newer technique for management of patients with GOO. We conducted a systematic review and meta-analysis to assess the overall technical and clinical success and adverse events of EUS-GE. 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 these identified studies were then manually searched to detect any additional studies. The primary outcome of our meta-analysis was assessment of the overall pooled technical and clinical success of this procedure. Secondary outcome included overall adverse events associated with it. The meta-analysis was performed using Der Simonian and Laird random effect model. Results: A total of ten studies were included in the final meta-analysis, reporting 263 patients (males 135 and females 128) with a median age of 61.2 years. The median follow-up duration was 110 days. The 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) respectively. The overall adverse events were 8.1% (95%CI= 4.1-11.9, I2 =23%), which included stent migration (n=2) and peritoneal stent deployment (n=15). Conclusion: EUS-GE appears to be a safe and effective endoscopic technique in patients with GOO, with overall high technical and clinical success rates (92.4%, 88.5% respectively), and reasonable safety profile. Although further randomized control trials are needed to validate these findings, our meta-analysis suggests that EUS-GE can be offered as a minimally invasive endoscopic alternative to GOO patients with challenging or failed enteral stenting, or those who are not deemed surgical candidates.809_A Figure 1. Forest plot demonstrating the overall technical success rate809_B Figure 2. Forest plot demonstrating the overall clinical success rate809_C Figure 3. Forest plot demonstrating the overall adverse event rates