EUS-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: Systematic review and meta-analysis

Background and study aims Endoscopic and surgical techniques have been utilized for palliation of gastric outlet obstruction (GOO). Enteral stenting (ES) is an established technique with high clinical success and low morbidity rate. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel approach that aims to provide sustained palliation of GOO. We conducted a comprehensive review and meta-analysis to evaluate the effectiveness in terms of clinical and technical success, as well as the safety profile of EUS-GE and ES. Methods We searched multiple databases from inception through July 2020 to identify studies that reported on safety and effectiveness of EUS- GE in comparison to ES. Pooled rates of technical success, clinical success, and adverse events (AEs) were calculated. Study heterogeneity was assessed using I-2% and 95% confidence interval. Results Five studies including 659 patients were included in our final analysis. Pooled rate of technical and clinical success for EUS- GE was 95.2% (CI 87.2-.98.3, I-2= 42) and 93.3% (CI 84.4-97.3, I-2=59) while for ES it was 96.9% (CI 90.9-99, I-2= 64) and 85.6% (CI 73-92.9, I-2= 85), respectively. Pooled rate of re- intervention was significantly lower with EUS-GE i. e. 4% (CI 1.8-8.7, I-2= 35) compared to ES, where it was 23.6% (CI 17.5-31, I-2= 35), p = 0.001. Pooled rates of overall and major AEs were comparable between the two techniques. Conclusion EUS- GE is comparable in terms of technical and clinical effectiveness and has a similar safety profile when compared to ES for palliation of GOO.