Endoscopic ultrasound-guided gastroenterostomy vs surgical gastrojejunostomy for malignant gastric outlet obstruction: a systematic review and meta-analysis.

BACKGROUND

Patients with malignant gastric outlet obstruction (GOO) require intervention to restore gastric emptying. Surgical gastrojejunostomy (SGJ) is effective but is associated with slower recovery and higher complication rates. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative, but comparative evidence remains limited.

METHODS

A systematic review and meta-analysis was conducted, including studies that compared EUS-GE and SGJ for malignant GOO. Primary outcomes were technical success, clinical success, and adverse events. Secondary outcomes included procedure duration, time to oral intake, diet tolerance, hospital stay, surgical reintervention, and overall mortality. Pooled analyzes were performed using random-effects models, with heterogeneity assessed using I².

RESULTS

A total of 12 studies, including 22,118 patients (4954 EUS-GE and 17,164 SGJ), were included. EUS-GE had lower technical success (odds ratio [OR] 0.25; P =.0002) but higher clinical success (OR 1.51; P =.04). EUS-GE was associated with a shorter procedure time (-93.8 min; P <.0001), earlier oral intake (-2.5 days; P =.002), and a shorter hospital stay (-4.91 days; P <.0001). It required fewer reinterventions (OR 0.39; P =.02), had fewer adverse events (OR 0.39; P <.0001), and showed lower mortality (OR 0.59; P =.05). Diet tolerance was similar between the groups.

CONCLUSION

Although EUS-GE had lower technical success, likely because of procedural complexity and anatomical challenges, it was associated with higher clinical success, faster recovery, fewer complications, and a reduced need for reintervention compared with SGJ, supporting its role as a safe and effective minimally invasive alternative for malignant GOO.