Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(03): E496-E504
DOI: 10.1055/a-1341-0788
Original article

EUS-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: Systematic review and meta-analysis

Saurabh Chandan
1   Division of Gastroenterology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Shahab R. Khan
2   Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA.
,
Babu P. Mohan
3   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Aun R. Shah
4   Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States
,
Mohammad Bilal
5   Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Daryl Ramai
6   Internal Medicine, The Brooklyn Hospital Center, New York, United States
,
Neil Bhogal
4   Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States
,
Banreet Dhindsa
4   Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States
,
Lena L. Kassab
7   Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Shailendra Singh
8   Department of Medicine, West Virginia University Charleston Division, Charleston, West Virginia, United States
,
Suresh Ponnada
9   Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States
,
Andrew K. Nguyen
3   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Stephanie McDonough
3   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Douglas G. Adler
3   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abtract

Background and study aims Endoscopic and surgical techniques have been utilized for palliation of gastric outlet obstruction (GOO). Enteral stenting (ES) is an established technique with high clinical success and low morbidity rate. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel approach that aims to provide sustained palliation of GOO. We conducted a comprehensive review and meta-analysis to evaluate the effectiveness in terms of clinical and technical success, as well as the safety profile of EUS-GE and ES.

Methods We searched multiple databases from inception through July 2020 to identify studies that reported on safety and effectiveness of EUS-GE in comparison to ES. Pooled rates of technical success, clinical success, and adverse events (AEs) were calculated. Study heterogeneity was assessed using I2% and 95 % confidence interval.

Results Five studies including 659 patients were included in our final analysis. Pooled rate of technical and clinical success for EUS-GE was 95.2 % (CI 87.2-.98.3, I2 = 42) and 93.3 % (CI 84.4–97.3, I2 = 59) while for ES it was 96.9 % (CI 90.9–99, I2 = 64) and 85.6 % (CI 73–92.9, I2 = 85), respectively. Pooled rate of re-intervention was significantly lower with EUS-GE i. e. 4 % (CI 1.8–8.7, I2 = 35) compared to ES, where it was 23.6 % (CI 17.5–31, I2 = 35), p = 0.001. Pooled rates of overall and major AEs were comparable between the two techniques.

Conclusion EUS-GE is comparable in terms of technical and clinical effectiveness and has a similar safety profile when compared to ES for palliation of GOO.

Supplementary material



Publication History

Received: 18 September 2020

Accepted: 27 November 2020

Article published online:
22 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Del Piano M, Ballarè M, Montino F. et al. Endoscopy or surgery for malignant GI outlet obstruction?. Gastrointest Endosc 2005; 61: 421-426
    CrossrefPubMedGoogle Scholar
  • 2 Pinto Pabón IT, Díaz LP, Ruiz De Adana JC. et al. Gastric and duodenal stents: follow-up and complications. Cardiovasc Intervent Radiol 2001; 24: 147-153
    CrossrefPubMedGoogle Scholar
  • 3 Warshaw AL, Fernández-del Castillo C. Pancreatic carcinoma. N Engl J Med 1992; 326: 455-465
    CrossrefPubMedGoogle Scholar
  • 4 Fukami N, Anderson MA, Khan K. et al. The role of endoscopy in gastroduodenal obstruction and gastroparesis. Gastrointest Endosc 2011; 74: 13-21
    CrossrefPubMedGoogle Scholar
  • 5 Itoi T, Baron TH, Khashab MA. et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Digestive Endoscopy 2017; 29: 495-502
    CrossrefPubMedGoogle Scholar
  • 6 Maetani I, Tada T, Ukita T. et al. Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 2004; 36: 73-78
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Takeno A, Takiguchi S, Fujita J. et al. Clinical outcome and indications for palliative gastrojejunostomy in unresectable advanced gastric cancer: multi-institutional retrospective analysis. Ann Surg Oncol 2013; 20: 3527-3533
    CrossrefPubMedGoogle Scholar
  • 8 van der Schelling GP, van den Bosch RP, Klinkenbij JH. et al. Is there a place for gastroenterostomy in patients with advanced cancer of the head of the pancreas?. World J Surg 1993; 17: 128-132 ; discussion 132–123
    CrossrefPubMedGoogle Scholar
  • 9 Weaver DW, Wiencek RG, Bouwman DL. et al. Gastrojejunostomy: is it helpful for patients with pancreatic cancer?. Surgery 1987; 102: 608-613
    PubMedGoogle Scholar
  • 10 Wong YT, Brams DM, Munson L. et al. Gastric outlet obstruction secondary to pancreatic cancer: surgical vs endoscopic palliation. Surg Endosc 2002; 16: 310-312
    CrossrefPubMedGoogle Scholar
  • 11 Yim HB, Jacobson BC, Saltzman JR. et al. Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 2001; 53: 329-332
    CrossrefPubMedGoogle Scholar
  • 12 Hosono S, Ohtani H, Arimoto Y. et al. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol 2007; 42: 283-290
    CrossrefPubMedGoogle Scholar
  • 13 Irani S, Baron TH, Itoi T. et al. Endoscopic gastroenterostomy: techniques and review. Curr Opin Gastroenterol 2017; 33: 320-329
    CrossrefPubMedGoogle Scholar
  • 14 Jeurnink SM, Steyerberg EW, van Eijck CH. et al. [Gastrojejunostomy versus endoscopic stent placement as palliative treatment for a malignant constriction of the duodenum: the SUSTENT-study]. Ned Tijdschr Geneeskd 2006; 150: 2270-2272
    PubMedGoogle Scholar
  • 15 Jeurnink SM, Steyerberg EW, Hof G. et al. Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. J Surg Oncol 2007; 96: 389-396
    CrossrefPubMedGoogle Scholar
  • 16 Duan B, Guo J, Ge N. et al. Preliminary use of a double-flanged, fully covered, self-expandable, metal stent with cautery in endoscopic ultrasound-guided gastroenterostomy. Endoscopy 2018; 50: E29-E31
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Mahler MA, Prieto RG, Oria I. et al. Single-session EUS-guided hepaticogastrostomy and dual-scope gastroenterostomy: a modified technique for palliative double endoscopic biliary and gastric bypass. Endoscopy 2018; 50: 78-79
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Hu J, Zhang K, Sun S. Endoscopic ultrasound-guided retrievable puncture anchor-assisted gastroenterostomy. Digest Endosc 2019; 31: e11-e12
    PubMedGoogle Scholar
  • 19 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
  • 20 Sakamoto Y, Hijioka S, Maruki Y. et al. Endoscopic ultrasound-guided gastroenterostomy using a metal stent for the treatment of afferent loop syndrome. Endoscopy 2019; 51: E153-E155
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: The prisma statement. Annals Intern Med 2009; 151: 264-269
    CrossrefPubMedGoogle Scholar
  • 22 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
  • 23 Chen YI, James TW, Agarwal A. et al. EUS-guided gastroenterostomy in management of benign gastric outlet obstruction. Endosc Int Open 2018; 6: E363-E368
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Kerdsirichairat T, Yang J, Gutierrez OIB. et al. Long-term outcomes of endoscopic ultrasound-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction: A 4-year cohort. Gastrointest Endosc 2018; 87: AB320-AB321
    CrossrefPubMedGoogle Scholar
  • 25 Khashab MA, Kumbhari V, Grimm IS. et al. EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc 2015; 82: 932-938
    CrossrefPubMedGoogle 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 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
  • 29 Barthet M, Binmoeller KF, Vanbiervliet G. et al. Natural orifice transluminal endoscopic surgery gastroenterostomy with a biflanged lumen-apposing stent: First clinical experience (with videos). Gastrointest Endosc 2015; 81: 215-218
    CrossrefPubMedGoogle Scholar
  • 30 Ngamruengphong S, Kumbhari V, Tieu AH. et al. A novel “balloon/snare apparatus” technique to facilitate easy creation of fistula tract during EUS-guided gastroenterostomy (EUS-GE). Gastrointest Endosc 2016; 83: AB636
    CrossrefPubMedGoogle Scholar
  • 31 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
  • 32 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
  • 33 Bondi G, Bazarbashi AN, Abbas AM. et al. Endoscopic gastroenterostomy versus surgical gastrojejunostomy for the treatment of gastric outlet obstruction in patients with peritoneal carcinomatosis: a retrospective comparative study. Gastrointest Endosc 2020; 91: AB303
    CrossrefPubMedGoogle Scholar
  • 34 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
    CrossrefPubMedGoogle Scholar
  • 35 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedGoogle Scholar
  • 36 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
    CrossrefPubMedGoogle Scholar
  • 37 Sutton A JAK, Jones DR. et al. Methods for meta-analysis in medical research. New York: J. Wiley; 2000
    Google Scholar
  • 38 Mohan BP, Adler DG. Heterogeneity in systematic review and meta-analysis: how to read between the numbers. Gastrointest Endosc 2019; 89: 902-903
    CrossrefPubMedGoogle Scholar
  • 39 Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 2009; 172: 137-159
    CrossrefPubMedGoogle Scholar
  • 40 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
    CrossrefPubMedGoogle Scholar
  • 41 Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455-463
    CrossrefPubMedGoogle Scholar
  • 42 Rothstein HR, Sutton AJ, Borenstein M. Publication bias in meta-analysis: Prevention, assessment and adjustments. John Wiley & Sons; 2006
    Google Scholar
  • 43 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; 33: 3404-3411
    CrossrefPubMedGoogle Scholar
  • 44 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 (vol 31, pg 2946, 2017). Surg Endosc Other Intervent Tec 2017; 31: 3765-3765
    PubMedGoogle Scholar
  • 45 Iqbal U, Berger A, Confer B. et al. Endoscopic ultrasound-guided gastroenterostomy vs enteral stenting for treatment of gastric outlet obstruction: A retrospective review. Am J Gastroenterol 2019; 114: S536-S537
    CrossrefPubMedGoogle Scholar
  • 46 Marya N, Jaruvongvanich V, Abu Dayyeh BK. et al. A multicenter international study comparing clinical outcomes of EUS-guided gastrojejunostomy, surgical gastrojejunostomy, and enteral stenting for patients with gastric outlet obstruction. Gastrointest Endosc 2020; 91: AB302-AB303
    CrossrefPubMedGoogle Scholar
  • 47 Vazquez-Sequeiros E, Sanchez-Aldehuelo R, de Santiago ER. et al. Endoscopic Ultrasound-Guided Gastrojejunostomy Is Superior to Duodenal Self Expandable Metal Stent for Pallitaive Treatment of Malignant Gastric Outlet Obstructtion: A Comparative Case Control Study. Gastrointestinal Endoscopy 2020; 91: AB312-AB313
    CrossrefPubMedGoogle Scholar
  • 48 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. Surgical Endoscopy 2017; 31: 2946-2952
    CrossrefPubMedGoogle Scholar
  • 49 Topazian M, Ring E, Grendell J. Palliation of obstructing gastric cancer with steel mesh, self-expanding endoprostheses. Gastrointest Endosc 1992; 38: 58-60
    CrossrefPubMedGoogle Scholar
  • 50 van Halsema EE, Rauws EA, Fockens P. et al. Self-expandable metal stents for malignant gastric outlet obstruction: A pooled analysis of prospective literature. World J Gastroenterol 2015; 21: 12468-12481
    CrossrefPubMedGoogle Scholar
  • 51 Gaidos JK, Draganov PV. Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents. World J Gastroenterol 2009; 15: 4365-4371
    CrossrefPubMedGoogle Scholar
  • 52 Zheng B, Wang X, Ma B. et al. Endoscopic stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Dig Endosc 2012; 24: 71-78
    CrossrefPubMedGoogle Scholar
  • 53 Mehta S, Hindmarsh A, Cheong E. et al. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc 2006; 20: 239-242
    CrossrefPubMedGoogle Scholar
  • 54 Fiori E, Lamazza A, Volpino P. et al. Palliative management of malignant antro-pyloric strictures Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res 2004; 24: 269-271
    PubMedGoogle Scholar
  • 55 Iqbal U, Khara HS, Hu Y. et al. EUS-guided gastroenterostomy for the management of gastric outlet obstruction: A systematic review and meta-analysis. Endoscopic Ultrasound 2020; 9: 16-23
    CrossrefPubMedGoogle Scholar
  • 56 McCarty TR, Garg R, Thompson CC. et al. Effectiveness and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E1474-E1482
    Article in Thieme ConnectPubMedGoogle Scholar
  • 57 Fan W, Tan S, Wang J. et al. Clinical outcomes of endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a systematic review and meta-analysis. Minim Invasive Ther Allied Technol 2020; 1-9
    CrossrefPubMedGoogle Scholar