EUS-Guided Gastroenterostomy for Benign Gastric Outlet Obstruction

Background and Aims: Gastric outlet obstruction (GOO) is a clinical manifestation of mechanical obstruction at the antropyloric region or proximal small bowel. The goal of endoscopic management is to relieve the obstruction so patients can resume per oral intake. Most studies have focused on malignant causes of GOO; yet only a handful have explored outcomes related to benign etiologies. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a novel method to bypass the obstruction with a lumen apposing metal stent. In this systematic review and meta-analysis, we aim to explore the technical and clinical success of EUS-GE for benign GOO. Methods: Multiple databases were searched for studies looking at EUS-GE for benign GOO from inception until July 2024. The primary outcome was technical and clinical success. Secondary outcomes included rates of reintervention and adverse events (AE). Results: Ten studies met inclusion criteria (n=181 patients). The most common etiologies were from chronic (n=48) and acute (n=41) pancreatitis followed by peptic strictures (n=19) and surgical anastomotic strictures (n=13). The mean procedure time was 66 minutes. The pooled rate of technical success was 95% (95% CI: 87.34-98.16; I 2 =0%). The pooled rate of clinical success was 90.6% (95% CI: 81.1-95.4; I 2 =0%). Total adverse events and reintervention rates were 11% (95% CI: 6.06-22.33; I 2 =38.7%) and 7% (95% CI: 2.23-20.95; I 2 =35.9%), respectively. Conclusion: The results of this meta-analysis demonstrate the efficacy and relative safety profile of EUS-GE for benign GOO. Further studies are needed to determine the optimal patient selection related to clinical success based on the underlying etiology.