Gastrointestinal endoscopy · 2026
Clinical Efficacy of Endoscopic Ultrasound-Guided Gastroenterostomy, Enteral Stenting, and Surgical Gastrojejunostomy for Malignant Gastric Outlet Obstruction: A Network Meta-Analysis.
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Peng Yu-Ning, Faucher-Jabado Ghina, Benmassaoud Amine, Martel Myriam, Al Alawi Said, Chapelle Nicolas, Albader Farah, Ahmed Nabeel, Metrakos Peter, Chaudhury Prosanto, Zogopoulos George, Calo Natalia Causada, Spadaccini Marco, Barkun Jeffrey, Barkun Alan, Chen Yen-I
Аннотация
BACKGROUND AND AIMS: Treatment options for malignant gastric outlet obstruction (MGOO) include endoscopic ultrasound-guided gastroenterostomy (EUS-GE), enteral stenting (ES), and surgical gastrojejunostomy (SGJ). We aim to provide a comprehensive comparative assessment of these interventions.
METHODS: We performed a systematic review and Bayesian network meta-analysis (NMA) of RCTs and cohort studies with causal adjustment comparing EUS-GE to ES, EUS-GE to SGJ, or SGJ to ES for MGOO (CRD420251133918). We searched PubMed, Embase, and Web of Science. Outcomes included re-intervention, clinical success, adverse events, length of hospitalization, time to oral intake, and technical success. Transitivity was assessed by comparing key effect modifiers, and consistency through Bayesian node-splitting. Sensitivity analysis restricted to RCTs only.
RESULTS: Six RCTs and ten causally adjusted cohort studies involving 1585 patients (376 EUS-GE, 726 ES, and 483 SGJ) were included. Baseline characteristics were comparable. EUS-GE demonstrated lower re-intervention rates than ES [risk ratio (RR) = 0.17; 95% credible interval (CrI), 0.07-0.35) and SGJ (RR = 0.3; 95% CrI, 0.11-0.65). Clinical success was higher with EUS-GE compared with ES (RR = 1.20; 95% CrI, 1.13-1.29) and SGJ (RR = 1.17; 95% CrI, 1.10-1.26). EUS-GE also shortened length of hospitalization (MD = -6.00; 95% CrI, -8.38 to -3.14) and time to oral intake (MD = -2.18; 95% CrI, -3.93 to -0.63) compared with SGJ. Based on direct pairwise comparisons, technical success did not differ among the three groups; however, network meta-analysis showed a higher technical success rate for SGJ compared with ES and EUS-GE. SUCRA rankings favored EUS-GE across most outcomes (re-intervention, clinical success, adverse events, length of hospitalization, and time to oral intake). Only minor inconsistency was detected, and sensitivity analyses were consistent with the primary analysis.
CONCLUSIONS: EUS-GE is associated with better clinical outcomes to ES and SGJ for MGOO. Future studies are needed to evaluate outcomes outside expert centers.
METHODS: We performed a systematic review and Bayesian network meta-analysis (NMA) of RCTs and cohort studies with causal adjustment comparing EUS-GE to ES, EUS-GE to SGJ, or SGJ to ES for MGOO (CRD420251133918). We searched PubMed, Embase, and Web of Science. Outcomes included re-intervention, clinical success, adverse events, length of hospitalization, time to oral intake, and technical success. Transitivity was assessed by comparing key effect modifiers, and consistency through Bayesian node-splitting. Sensitivity analysis restricted to RCTs only.
RESULTS: Six RCTs and ten causally adjusted cohort studies involving 1585 patients (376 EUS-GE, 726 ES, and 483 SGJ) were included. Baseline characteristics were comparable. EUS-GE demonstrated lower re-intervention rates than ES [risk ratio (RR) = 0.17; 95% credible interval (CrI), 0.07-0.35) and SGJ (RR = 0.3; 95% CrI, 0.11-0.65). Clinical success was higher with EUS-GE compared with ES (RR = 1.20; 95% CrI, 1.13-1.29) and SGJ (RR = 1.17; 95% CrI, 1.10-1.26). EUS-GE also shortened length of hospitalization (MD = -6.00; 95% CrI, -8.38 to -3.14) and time to oral intake (MD = -2.18; 95% CrI, -3.93 to -0.63) compared with SGJ. Based on direct pairwise comparisons, technical success did not differ among the three groups; however, network meta-analysis showed a higher technical success rate for SGJ compared with ES and EUS-GE. SUCRA rankings favored EUS-GE across most outcomes (re-intervention, clinical success, adverse events, length of hospitalization, and time to oral intake). Only minor inconsistency was detected, and sensitivity analyses were consistent with the primary analysis.
CONCLUSIONS: EUS-GE is associated with better clinical outcomes to ES and SGJ for MGOO. Future studies are needed to evaluate outcomes outside expert centers.