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

  • Systematic Reviews and Meta-analyses
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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.

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Availability of data and material

The “30-day all-cause mortality” outcome was performed with data from Chen et al. [26] obtained by contacting the authors.

Code availability

Not applicable.

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Authors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Universidade de São Paulo Hospital das Clínicas, Av. Dr Enéas de Carvalho Aguiar, 255. 6° andar, bloco 3, Cerqueira César, Sao Paulo, 05403-000, Brazil

    Mateus Bond Boghossian, Mateus Pereira Funari, Diogo Turiani Hourneaux De Moura, Vitor Massaro Takamatsu Sagae, Pastor Joaquín Ortiz Mendieta, Fernando Lopes Ponte Neto, Wanderley Marques Bernardo, Marcos Eduardo Lera dos Santos & Eduardo Guimarães Hourneaux de Moura

  2. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Thomas R McCarty

  3. Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC, Canada

    Yen-I Chen

  4. Rua Isabel Schmidt, Universidade Santo Amaro, 349 - Santo Amaro, São Paulo, SP, 04743-030, Brazil

    Filipe Tomishige Chaves

  5. Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA

    Mouen A Khashab

Authors
  1. Mateus Bond Boghossian
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Contributions

Study conception and design: Mateus Bond Boghossian, Mateus Pereira Funari, Diogo Turiani Hourneaux De Moura, Vitor Massaro Takamatsu Sagae, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura. Acquisition of data: Mateus Bond Boghossian, Pastor Joaquín Ortiz Mendieta, Fernando Lopes Ponte Neto, Filipe Tomishige Chaves. Analysis and interpretation of data: 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, Filipe Tomishige Chaves, Mouen A Khashab, Eduardo Guimarães Hourneaux de Moura. Drafting of manuscript: Mateus Bond Boghossian, Mateus Pereira Funari, Diogo Turiani Hourneaux De Moura, Thomas R McCarty, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura. Critical revision of manuscript: Mateus Pereira Funari, Diogo Turiani Hourneaux De Moura, Thomas R McCarty, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura

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Correspondence to Mateus Bond Boghossian.

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The project was approved by the Ethics Committee of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

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Boghossian, M.B., Funari, M.P., De Moura, D.T.H. et al. EUS-guided gastroenterostomy versus duodenal stent placement and surgical gastrojejunostomy for the palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis. Langenbecks Arch Surg 406, 1803–1817 (2021). https://doi.org/10.1007/s00423-021-02215-8

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