Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(11): E1474-E1482
DOI: 10.1055/a-0996-8178
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis

Thomas R. McCarty
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Rajat Garg
3   Cleveland Clinic, Cleveland, Ohio, United States
,
Christopher C. Thompson
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Tarun Rustagi
4   Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, United States
› Author Affiliations
Further Information

Publication History

submitted 12 June 2019

accepted after revision 31 July 2019

Publication Date:
23 October 2019 (online)

Also available at
   Permissions and Reprints

Abstract

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel endoscopic procedure designed to facilitate sustained luminal patency in patients with gastric outlet obstruction. The primary aim of this study was to evaluate the efficacy and safety of EUS-GE for treatment of gastric outlet obstruction.

Methods Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed through April 2019. Patients with benign and malignant gastric outlet obstruction were included. Measured outcomes included: immediate technical and clinical success as well as rate of serious adverse events (AEs). Heterogeneity was assessed with Cochran Q test and I 2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing.

Results A total of five studies (n = 199 patients; 45.73 % male) were included in this study. Four retrospective studies and one prospective study were analyzed. Mean age of patients that underwent the EUS-GE procedure was 64.52 ± 1.37 years with a pooled mean follow-up period of 4.32 ± 1.65 months. In 21 % of patients (n = 43), gastric outlet obstruction was due to benign causes. Immediate technical success was 92.90 % (95 % CI; 88.26 – 95.79; I2 = 0.00 %) and reported in all studies. The clinical success rate of EUS-GE was 90.11 % (95 % CI; 84.64 – 93.44; I2 = 0.00 %). Serious AEs occurred in 5.61 % (95 % CI; 2.87 – 10.67; I2 = 1.67 %) of cases and were related to peritonitis, perforation, bleeding, and abdominal pain. Re-intervention rate was 11.43 % (95 % CI; 7.29 – 17.46; I2 = 17.38 %).

Conclusions EUS-GE appears to provide an effective and safe minimally invasive alternative for treatment of benign and malignant gastric outlet obstruction.

Supplementary material

 

  • References

  • 1 Chowdhury A, Dhali GK, Banerjee PK. Etiology of gastric outlet obstruction. Am J Gastroenterol 1996; 91: 1679
    PubMedGoogle Scholar
  • 2 Johnson CD. Gastric outlet obstruction malignant until proved otherwise. Am J Gastroenterol 1995; 90: 1740
    PubMedGoogle Scholar
  • 3 Johnson CD, Ellis H. Gastric outlet obstruction now predicts malignancy. Br J Surg 1990; 77: 1023-1024
    CrossrefPubMedGoogle Scholar
  • 4 Shone DN, Nikoomanesh P, Smith-Meek MM. et al. Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. Am J Gastroenterol 1995; 90: 1769-1770
    PubMedGoogle Scholar
  • 5 Storm AC, Ryou M. Advances in the endoscopic management of gastric outflow disorders. Curr Opin Gastroenterol 2017; 33: 455-460
    CrossrefPubMedGoogle Scholar
  • 6 Khashab M, Alawad AS, Shin EJ. et al. Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 2013; 27: 2068-2075
    CrossrefPubMedGoogle Scholar
  • 7 Itoi T, Baron TH, Khashab MA. et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc 2017; 29: 495-502
    CrossrefPubMedGoogle Scholar
  • 8 Rimbas M, Larghi A, Costamagna G. Endoscopic ultrasound-guided gastroenterostomy: Are we ready for prime time?. Endosc Ultrasound 2017; 6: 235-240
    CrossrefPubMedGoogle Scholar
  • 9 Amin S, Sethi A. Endoscopic ultrasound-guided gastrojejunostomy. Gastrointest Endosc Clin N Am 2017; 27: 707-713
    CrossrefPubMedGoogle Scholar
  • 10 Fritscher-Ravens A, Mosse CA, Mills TN. et al. A through-the-scope device for suturing and tissue approximation under EUS control. Gastrointest Endosc 2002; 56: 737-742
    CrossrefPubMedGoogle Scholar
  • 11 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals Internal Med 2009; 151: W65-W94
    PubMedGoogle Scholar
  • 12 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012
    CrossrefPubMedGoogle Scholar
  • 13 Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002; 97: 72-78
    CrossrefPubMedGoogle Scholar
  • 14 DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clin Trials 1986; 7: 177-188
    CrossrefPubMedGoogle Scholar
  • 15 Stuart A, Ord JK. Kendall’s Advanced Theory of Statistics. 6th ed. London: Edward Arnold; 1994
    Google Scholar
  • 16 McCarty TR, Itidiare M, Njei B. et al. Efficacy of transoral incisionless fundoplication for refractory gastroesophageal reflux disease: a systematic review and meta-analysis. Endoscopy 2018; 50: 708-725
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 McCarty TR, Njei B. Self-expanding metal stents for acute refractory esophageal variceal bleeding: A systematic review and meta-analysis. Dig Endosc 2016; 28: 539-547
    CrossrefPubMedGoogle Scholar
  • 18 Wells G, Shea B. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. 3rd Symposium on Systematic Reviews: Beyond the Basics; July 3–5; Oxford. 2000. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp [Accessed 11 April 2019]
    PubMedGoogle Scholar
  • 19 Jadad AR, Moore RA, Carroll D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12
    CrossrefPubMedGoogle Scholar
  • 20 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
    CrossrefPubMedGoogle Scholar
  • 21 Egger M, Davey Smith G. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
    CrossrefPubMedGoogle Scholar
  • 22 Easterbrook PJ, Berlin JA, Gopalan R. et al. Publication bias in clinical research. Lancet 1991; 337: 867-872
    CrossrefPubMedGoogle Scholar
  • 23 Chen YI, Kunda R, Storm AC. et al. EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques. Gastrointest Endosc 2018; 87: 1215-1221
    CrossrefPubMedGoogle Scholar
  • 24 Ge PS, Young JY, Dong W. et al. EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction. Surg Endosc 2019; DOI: 10.1007/s00464-018-06636-3. [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 25 Kerdsirichairat T, Irani S, Yang J. et al. Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction. Endosc Int Open 2019; 7: E144-E150
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Tyberg A, Perez-Miranda M, Sanchez-Ocana R. et al. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 2016; 4: E276-E281
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Itoi T, Ishii K, Ikeuchi N. et al. Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction. Gut 2016; 65: 193-195
    CrossrefPubMedGoogle Scholar
  • 28 Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. Available from: http://handbook-5-1.cochrane.org [Accessed 9 April 2019]
    PubMedGoogle Scholar
  • 29 Itoi T, Binmoeller KF, Shah J. et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc 2012; 75: 870-876
    CrossrefPubMedGoogle Scholar
  • 30 Binmoeller KF, Shah JN. Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study. Endoscopy 2012; 44: 499-503
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Jeurnink SM, van Eijck CH, Steyerberg EW. et al. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol 2007; 7: 18
    CrossrefPubMedGoogle Scholar
  • 32 Jeurnink SM, Steyerberg EW, van Hooft JE. et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71: 490-499
    CrossrefPubMedGoogle Scholar
  • 33 Khashab MA, Bukhari M, Baron TH. et al. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open 2017; 5: E275-E281
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Perez-Miranda M, Tyberg A, Poletto D. et al. EUS-guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. J Clin Gastroenterol 2017; 51: 896-899
    CrossrefPubMedGoogle Scholar
  • 35 Chen YI, Itoi T, Baron TH. et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 2017; 31: 2946-2952
    CrossrefPubMedGoogle Scholar