2941 Endoscopic Ultrasound-Guided Gastroenterostomy for the Management of Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Gastric outlet syndrome (GOO) is characterized by epigastric pain and postprandial vomiting secondary to mechanical obstruction. Management of GOO is usually focused on alleviating the symptoms of obstruction and can be achieved by surgical gastrojejunostomy or enteral stenting. Recent studies have shown success with endoscopic ultrasound guided gastroenterostomy (EUS-GE) in the management of GOO but data is limited. We therefore conducted a meta-analysis to evaluate the safety and efficacy of EUS-GE in the management of GOO. METHODS: A comprehensive literature review was conducted by searching the several databases from inception to January 2019 to identify all studies that evaluate the efficacy and safety of EUS-GE in GOO. Our primary outcome was to evaluate technical success and clinical success. Technical success was defined as successful EUS guided deployment luminal apposing stent (LAMS). Clinical success was defined as ability to tolerate oral intake after the procedure. Secondary outcomes were to evaluate need for reintervention and adverse events of the procedure. RESULTS: Twelve studies including 285 patients were included in the meta-analysis. Among 12 included studies 3 were case series, 1 prospective and 8 retrospective cohort studies. 7 of the included studies were good quality studies while 5 were of fair quality. EUS-GE was performed in 202 patients with GOO secondary to malignancy while 83 patients had benign etiologies of GOO. Technical success was achieved in 266 patients out 308 patients who underwent EUS-GE with a pooled technical success of 92% [95% CI: 88%-95%]. Clinical success was achieved in 249 patients with a pooled clinical success rate of 90% [95% CI: 85%-94%]. Adverse events occurred in 28 patients with a pooled incidence of 12% [95% CI: 9%-17%]. Recurrence of GOO symptoms and need for unplanned re-intervention was needed in 16 patients with a pooled incidence of 9% [95% CI: 6%-13%]. There was no statistical heterogeneity existed among the included studies (I2 = 0%, P > 0.05). Egger's test indicated no publication bias as the symmetry existed in the funnel plot (P > 0.05). CONCLUSION: EUS-GE is safe and efficacious treatment modality for the management of benign and malignant GOO. EUS-GE is also comparable to enteral stenting and may be associated with fewer adverse effects and need for re-intervention compared to enteral stenting. Larger prospective trials are needed to compare the efficacy of EUS-GE with endoscopic duodenal stenting and SGJ in GOO.