EUS-guided gastroenterostomy versus duodenal stent placement and surgical gastrojejunostomy for the palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis

Mateus Bond Boghossian, Mateus Pereira Funari, Diogo Turiani Hourneaux De Moura, Thomas R. McCarty, Vitor Massaro Takamatsu Sagae, Yen I. Chen, Pastor Joaquín Ortiz Mendieta, Fernando Lopes Ponte Neto, Wanderley Marques Bernardo, Marcos Eduardo Lera dos Santos, Filipe Tomishige Chaves, Mouen A. Khashab, Eduardo Guimarães Hourneaux de Moura

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Malignant gastric outlet obstruction (GOO) is associated with significant morbidity and decreased quality of life, thereby necessitating effective and safe palliative treatment. As such, we sought to compare endoscopic ultrasound-guided gastroenterostomy (EUS-GE) versus duodenal stent (DS) placement and surgical gastrojejunostomy (SGJ) for palliation of malignant GOO. Methods: Searches of electronic databases were performed to identify studies comparing EUS-GE versus DS and/or SGJ for palliative treatment of GOO. Outcomes included technical and clinical success, severe adverse events (SAEs), rate of stent obstruction (including tumor ingrowth), length of hospital stay (LOS), reintervention, and 30-day all-cause mortality. Differences in dichotomous and continuous outcomes were reported as risk difference and mean difference, respectively. Results: Seven studies (n = 513 patients) were included. When compared to DS placement, EUS-GE was associated with a higher clinical success, fewer SAEs, decreased stent obstruction, lower rate of tumor ingrowth, and decreased need for reintervention. Compared to SGJ, EUS-GE was associated with a lower technical success; however, LOS was significantly decreased. All other outcomes including clinical success, SAEs, reintervention rate, and 30-day mortality were not significantly different between an EUS-guided versus surgical approach. Conclusions: EUS-GE was associated with significantly improved outcomes compared to DS placement for palliative treatment of malignant GOO. Despite SGJ possessing a higher technical success compared to EUS-GE, LOS was significantly longer with no difference in clinical success or rate of adverse events.

Original languageEnglish (US)
JournalLangenbeck's Archives of Surgery
DOIs
StateAccepted/In press - 2021

Keywords

  • Duodenal stent
  • Gastric outlet obstruction
  • Lumen-apposing metal stent
  • Surgical gastroenterostomy
  • Therapeutic endoscopic ultrasound

ASJC Scopus subject areas

  • Surgery

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