RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-1783-8949
Endoscopic ultrasound-guided gastroenterostomy versus surgical gastrojejunostomy in treatment of malignant gastric outlet obstruction: Systematic review and meta-analysis
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202204/lookinside/thumbnails/2404_10-1055-a-1783-8949-1.jpg)
Abstract
Background and study aims Palliative treatment of malignant gastric outlet obstruction (GOO) has conventionally been with surgical gastrojejunostomy (SGJ). Advent of devices like lumen apposing metal stents has made endoscopic ultrasound-guided gastroenterostomy (EUS-GE) a potential alternative to SGJ for these patients. We performed a systematic review and meta-analysis of studies that compared outcomes of EUS-GE versus SGJ.
Methods We performed a comprehensive systematic search of multiple electronic databases and conference proceedings through January 2021 and identified six studies that compared outcomes of EUS-GE versus SGJ in the management of malignant GOO. The rates of technical success, clinical success, and AEs were analyzed, and pooled odds ratios were calculated using random effects model.
Results Six studies were included in our analysis with a total of 484 patients, of which 291 underwent EUS-GE and 193 underwent SGJ. The technical success rate of SGJ was superior to EUS-GE (OR = 0.195; 95 %CI:0.054–0.702; P = 0.012; I2 = 0). The clinical success of EUS-GE was statistically similar to SGJ (OR = 1.566; 95 %CI:0.585–4.197; P = 0.372; I2 = 46.68 %). EUS-GE had significantly fewer AEs compared to SGJ (OR = 0.295; 95 %CI:0.172–0.506; P < 0.005; I2 = 0). Among studies which reported reintervention rates, EUS-GE was statistically similar to SGJ (OR = 0.587; 95 %CI:0.174–1.979; P = 0.390, I2 = 54.91). Minimal to moderate heterogeneity was noted in the analyses.
Conclusions EUS-GE has equivalent clinical success and reintervention rates, but significantly lower adverse events compared to SGJ. When feasible, EUS-GE appears to be an effective and safe alternative to SGJ for palliative management of malignant GOO.
Publikationsverlauf
Eingereicht: 08. Mai 2021
Angenommen nach Revision: 12. Oktober 2021
Artikel online veröffentlicht:
14. April 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Van Heek NT, Van Geenen RCI, Busch ORC. et al. Palliative treatment in „peri“-pancreatic carcinoma: Stenting or surgical therapy?. Acta Gastroenterol Belg 2002; 65: 171-175
- 2 Johnsson E, Thune A, Liedman B. Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: Clinical outcome and health economic evaluation. World J Surg 2004; 28: 812-817
- 3 Jeurnink SM, Steyerberg EW, van Hooft JE. et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71: 490-499
- 4 ASGE Standards and Practice Committee. Fukami N, Anderson MA. et al. The role of endoscopy in gastroduodenal obstruction and gastroparesis. Gastrointest Endosc 2011; 74: 13-21
- 5 Khashab M, Alawad AS, Shin EJ. et al. Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 2013; 27: 2068-2075
- 6 Mehta S, Hindmarsh A, Cheong E. et al. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc Other Interv Tech 2006; 20: 239-242
- 7 Khashab MA, Baron TH, Binmoeller KF. et al. EUS-guided gastroenterostomy: A new promising technique in evolution. Gastrointest Endosc 2015; 81: 1234-1236
- 8 Carbajo AY, Kahaleh M, Tyberg A. Clinical review of EUS-guided gastroenterostomy (EUS-GE). J Clin Gastroenterol 2020; 54: 1-7
- 9 Irani S, Baron TH, Itoi T. et al. Endoscopic gastroenterostomy: Techniques and review. Curr Opin Gastroenterol 2017; 33: 320-329
- 10 Itoi T, Ishii K, Ikeuchi N. et al. Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction. Gut 2016; 65: 193-195
- 11 Tyberg A, Perez-Miranda M, Sanchez-Ocaña R. et al. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 2016; 04: E276-E281
- 12 Khashab MA, Kumbhari V, Grimm IS. et al. EUS-guided gastroenterostomy: The first U.S. clinical experience (with video). Gastrointest Endosc 2015; 82: 932-938
- 13 Chen YI, Itoi T, Baron TH. et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 2017; 31: 2946-2952
- 14 Ge PS, Young JY, Dong W. et al. EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction. Surg Endosc 2019; 33: 3404-3411
- 15 Bondi G, Bazarbashi AN, Abbas AM. et al. Endoscopic gastroenterostomy versus surgical gastrojejunostomy for the treatment of gastric outlet obstruction in patients with peritoneal carcinomatosis: A retrospective comparative study. Gastrointest Endosc 2020; 91: 2020
- 16 Khashab M, Bukhari M, Baron T. et al. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open 2017; 05: E275-E281
- 17 Kouanda A, Binmoeller K, Hamerski C. et al. Endoscopic ultrasound-guided gastroenterostomy versus open surgical gastrojejunostomy: clinical outcomes and cost effectiveness analysis. Surg Endosc 2021; DOI: 10.1007/s00464-020-08221-z.
- 18 Perez-Miranda M, Tyberg A, Poletto D. et al. EUS-guided Gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. J Clin Gastroenterol 2017; 51: 896-899
- 19 Widmer JL, Winner M, Allendorf J. et al. Su1154 Single center comparative study of endoscopic gastrojejunostomy versus surgical gastrojejunostomy for malignant gastric outlet obstruction. Gastrointest Endosc 2019; 89: AB291
- 20 Marya N, Jaruvongvanich V, Dayyeh BKA. et al. A multicenter international study comparing clinical outcomes of EUS-guided gastrojejunostomy, surgical gastrojejunostomy, and enteral stenting for patients with gastric outlet obstruction. Gastrointest Endosc 2020; 91: 302-303
- 21 Higgins JP. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 updated March 2011. The Cochrane Collaboration. https://ci.nii.ac.jp/naid/20000796633
- 22 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 2009; 151: 264-269
- 23 Wells GA, Shea B, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
- 24 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
- 25 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213
- 26 Der Simonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
- 27 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 8. Rating the quality of evidence – Indirectness. J Clin Epidemiol 2011; 64: 1303-1310
- 28 Egger M, Smith GD, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
- 29 Duval S, Tweedie R. A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association 2012; 95: 89-98
- 30 Shone DN, Nikoomanesh P, Smith-Meek MM. et al. Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. Am J Gastroenterol 1995; 90: 1769-1770
- 31 van Hooft JE, Uitdehaag MJ, Bruno MJ. et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc 2009; 69: 1059-1066
- 32 Duarte-Chavez R, Kim M, Marino D. et al. Su1280 Endoscopic ultrasound-guided gastroenterostomy versus enteral stent versus surgical gastrojejunostomy: systematic review and pooled analysis. Gastrointest Endosc 2020; 91: AB308-AB309