Meta-analysis of endoscopic ultrasound guided gastrojejunostomy versus surgical gastroenterostomy for the management of gastric outlet obstruction.

AIMS: To evaluate comparative outcomes of endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) and surgical gastrojejunostomy (SGJ) for management of gastric outlet obstruction (GOO).

METHODS

A systematic search of electronic data sources was conducted and all comparative studies investigating outcomes of EUS-GJ and SGJ were identified and their risk of bias were evaluated. Technical success, clinical success, length of hospital stay, overall adverse events, postoperative Clavien-Dindo (C-D) ≥ III complications, time to soft intake, time to oral intake, time to initiation of chemotherapy, overall mortality, 30-day mortality, readmissions, reintervention, among other outcomes were evaluated.

RESULTS

Fourteen studies reporting a total of 22,337 patients were included (5172 EUS-GJ versus 17,165 SGJ). EUS-GJ was associated with significantly higher clinical success (OR 1.85, p = 0.02) and lower risk of overall morbidity (OR 0.28, p < 0.001), postoperative C-D > III complications (OR 0.44, p = 0.006) compared with SGJ. Moreover, it significantly shortened length of stay (MD -4.38, p < 0.0001), time to oral intake (MD -2.57, p < 0.0001), time to solid intake (MD -4.28, p = 0.027) or time to chemotherapy (MD -17.9, p < 0.0001). However, SGJ had significantly higher technical success (OR 0.34, p = 0.005). There was no significant difference in 30-day mortality (OR 1.03, p = 0.91), overall mortality (OR 0.98, p = 0.89) or reintervention (OR 0.77 p = 0.67) between groups.

CONCLUSIONS

Where available, EUS-GJ should be considered as the first-choice intervention for isolated GOO considering favourable clinical success and significantly lower perioperative morbidities when compared with SGJ. Surgical approach is indicated if EUS-GJ fails or in the presence of a simultaneous anatomical disturbance that requires surgical correction. Future research is needed.