920 Efficacy and Safety of EUS-Guided Gastroenterostomy for Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: For symptomatic gastric outlet obstruction (GOO), enteral stents or surgical gastroenterostomy (GE) are treatment options that are limited by short term efficacy or high procedural complication rates. With the advent of lumen apposing metal stents (LAMS) it is possible to use a minimally invasive EUS guided approach to create a gastro-enteric fistula. We conducted a systematic review and meta-analysis to evaluate and compare the efficacy and safety of EUS-guided gastroenterostomy for GOO. METHODS: MEDLINE, EMBASE, and SCOPUS were utilized to search for eligible studies that reported on technical success, clinical success and adverse events of this procedure from 2012-2019. Technical success was defined as the ability to create a GE with a LAMS and clinical success was defined as the ability to tolerate an oral diet. Patients with benign and malignant GOO were included. All studies were retrospective and the quality of eligible studies was assessed by the NHBLI tool. A sub-analysis was done to analyze the direct and balloon assisted techniques and procedural times. Figure 1 depicts the flow chart used for study screening. RESULTS: A total of 5 studies (n = 147 patients) were included in the analysis. The mean age of patients undergoing EUS guided GE was 64 years with 50% females. Most common etiology for GOO was malignancy with 77% of cases. Pooled technical success was 96% (95% CI 0.91-0.99) although 5 cases initially involved LAMS misdeployment requiring repositioning. Clinical success was 80% (95% CI 0.58-0.96) and a total of 6 adverse events (2% 95% CI 0.00 – 0.08) occurred including intra-procedural bleeding, peritonitis and perforation requiring surgery. Figures 2a–c highlights the technical success, clinical success and adverse events of EUS guided GE. On procedural sub-analysis, a total of 74 cases were done with the direct GE technique while 27 cases underwent balloon-assisted GE. Stent misdeployments occurred in 6.7% of cases of the direct technique and 9.1% of balloon assisted cases. Procedural time was comparatively lower with the direct technique averaging 35.6 mins compared to 84 mins for the balloon assisted technique. CONCLUSION: EUS guided gastroenterostomy is an efficacious and safe procedure for patients with gastric outlet obstruction. Although the direct GE technique appears to require less procedural time, more studies need to be done to assess the optimal procedural technique.