Su1282 OUTCOMES OF PALLIATION OF MALIGNANT GASTRIC OUTLET OBSTRUCTION USING EUS-GUIDED GASTROENTEROSTOMY VS. ENDOSCOPIC STENTING VS. SURGICAL GASTROJEJUNOSTOMY: A POOLED ANALYSIS

Abstract

Gastric outlet obstruction (GOO) results most commonly from malignancy leading to mechanical obstruction of the distal stomach or proximal duodenum. GOO is debilitating as it impairs the quality of life, and the nutritional and volume status of affected patients. Traditionally, surgical gastrojejunostomy (GJ) and self-expandable metal stents have been considered the mainstay treatment. More recently, Endoscopic ultrasound-guided gastroenterostomy (EUS-GE), using lumen-apposing metal stents, have been introduced as a third option. To date, a pooled analysis of the outcomes of comparative studies of these four techniques does not exist. The aim of this study was to provide a pooled estimate of these techniques' outcomes. PubMed, Web of Science, Google Scholar and Embase search was performed for eligible studies using the combination of the following terms: ‘gastric outlet obstruction', ‘duodenal obstruction', ‘neoplasm', ‘gastrojejunostomy', ‘laparoscopy', ‘laparotomy', ‘stents', ‘endoscopy', ‘endosonography' and ‘gastric bypass'. Original articles directly comparing two out of the four techniques (Open GJ vs. Laparoscopic GJ vs. Enteral stent vs. EUS-GE) for alleviating malignant gastric outlet obstruction were selected. The PRISMA flow diagram depicts the selection process. The primary outcomes were: overall pooled technical and clinical success. Secondary outcomes included pooled mean length of hospital stay and adverse events and complication rate. Studies performed on non-human subjects and those not differentiating the surgical approach used (open vs. laparoscopic) were excluded. Statistical software Open MetaAnalyst was used for analysis with pooled proportions and means reported with 95% Confidence intervals (CI) and heterogeneity (I2). Nineteen studies were included in the final analysis: 17 were retrospective and 2 were prospective. The pooled total number of patients was 1,853. Mean age was 68, 64, 66, and 64 for EUS-GE, enteral stent, open and lap GJ respectively. Reported mean follow-up duration was 175, 98, 140 and 650 days for EUS-GE, enteral stent, open and lap GJ respectively. The overall pooled clinical success rate was 89.3 (95%CI:82.7 – 95.8), 88 (95% CI:82.4-93.6), 89 (95%CI:82.3-95.7), and 92.3% (95%CI:86.6-97.9) for EUS-GE, enteral stent, open and lap GJ respectively. The overall pooled technical, clinical and complication rates, in addition to the mean length of stay are reported in table 1. The lowest heterogeneity among studied outcomes was found in the EUS-GE arm possibly correlating with a more standardized approach among the tertiary centers performing it. Herein we report based on our pooled analysis that EUS-GE appears to have comparable outcomes and safety profile to the more traditional techniques. EUS-GE is minimally invasive and has long-term efficacy in alleviating GOO.Table 1Overall pooled technical, clinical and complications rate, and mean length of hospital stay in each of the 4 arms. 95% CI: Confidence Interval; I2: heterogenity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)