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

Saurabh Chandan; Shahab R. Khan; Babu P. Mohan; Aun R. Shah; Mohammad Bilal; Daryl Ramai; Neil Bhogal; Banreet Dhindsa; Lena L. Kassab; Shailendra Singh; Suresh Ponnada; Andrew K. Nguyen; Stephanie McDonough; Douglas G. Adler

doi:10.1055/a-1341-0788

Endoscopy International Open, Inhaltsverzeichnis

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

¹Division of Gastroenterology, CHI Creighton University Medical Center, Omaha, Nebraska, United States

,

Shahab R. Khan

²Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA.

,

Babu P. Mohan

³Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States

,

Aun R. Shah

⁴Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States

,

Mohammad Bilal

⁵Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States

,

Daryl Ramai

⁶Internal Medicine, The Brooklyn Hospital Center, New York, United States

,

Neil Bhogal

⁴Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States

,

Banreet Dhindsa

⁴Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States

,

Lena L. Kassab

⁷Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States

,

Shailendra Singh

⁸Department of Medicine, West Virginia University Charleston Division, Charleston, West Virginia, United States

,

Suresh Ponnada

⁹Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States

,

Andrew K. Nguyen

³Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States

,

Stephanie McDonough

³Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States

,

Douglas G. Adler

³Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States

› Institutsangaben

Abstract

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.

Volltext

Referenzen

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