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Background and study aims <p>Afferent limb syndrome (ALS) is a rare condition resulting in a mechanical obstruction in the afferent loop after surgical gastrointestinal (GI) reconstruction. Endoscopic ultrasound (EUS)-guided gastrojejunostomy (GJ) or jejunojejunostomy (JJ) is increasing in clinical practice. Therefore, the aim of this systematic review with meta-analysis is to evaluate the efficacy and safety of EUS-GJ or EUS-JJ for ALS.</p> Patients and methods <p>The most important medical databases were systematically searched through May 2025. The primary outcome was technical success of EUS-GJ/JJ for ALS. Secondary outcomes were clinical success, safety, and recurrence rate. A random-effects model was used to pool the results. Heterogeneity was expressed as inconsistency index (I<sup>2</sup>) and explored through subgroup analyses.</p> Results <p>9 studies (all retrospective) involving 188 patients were included in the analysis. The weighted mean age was 65.38(± 10.57) years and the etiology of the ALS was mostly malignant. Technical success was 96.3% (CI95% 93.2–99.4%, I<sup>2</sup> = 0%). Clinical success was 95% (CI95% 91.2–98.7%, I<sup>2</sup> = 0%) and adverse events (AEs) rate was 6.9% (CI95% 2.9–11.1%, I<sup>2</sup> = 0%). Recurrence rate was 16.6% (CI95% 7.7–25.4%, I<sup>2</sup> = 43.79%). Subgroup analyses showed differences in the recurrence rate between the use of a fully covered self-expandable metal stent (FCSEMS) (35.9% [CI95% 20.3–51.6%, I<sup>2</sup> = 0%]) and a lumen-apposing metal stent (LAMS)(10.4% [CI95% 4–16.8%, I<sup>2</sup> = 0%], p = 0.003). Follow-up ranged from a median of 96.5 to 185&#xa0;days.</p> Conclusions <p>EUS-guided GI anastomosis is an effective treatment for ALS, showing high technical and clinical success rates and a low incidence of AEs. The use of LAMS over FCSEMS seems to reduce the recurrence rate, suggesting the routine use of LAMS in the case of EUS-guided GI anastomosis for treating ALS.</p>

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Endoscopic ultrasound-guided gastrointestinal anastomoses for the treatment of afferent limb syndrome: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年3月2日

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  • Giacomo Emanuele Maria Rizzo,
  • Giuseppe Vanella,
  • Lorenzo Fuccio,
  • Antonio Facciorusso,
  • Stefano Mazza,
  • Fausto Catena,
  • Carlo Fabbri,
  • Andrea Anderloni,
  • Ilaria Tarantino

摘要

Background and study aims

Afferent limb syndrome (ALS) is a rare condition resulting in a mechanical obstruction in the afferent loop after surgical gastrointestinal (GI) reconstruction. Endoscopic ultrasound (EUS)-guided gastrojejunostomy (GJ) or jejunojejunostomy (JJ) is increasing in clinical practice. Therefore, the aim of this systematic review with meta-analysis is to evaluate the efficacy and safety of EUS-GJ or EUS-JJ for ALS.

Patients and methods

The most important medical databases were systematically searched through May 2025. The primary outcome was technical success of EUS-GJ/JJ for ALS. Secondary outcomes were clinical success, safety, and recurrence rate. A random-effects model was used to pool the results. Heterogeneity was expressed as inconsistency index (I2) and explored through subgroup analyses.

Results

9 studies (all retrospective) involving 188 patients were included in the analysis. The weighted mean age was 65.38(± 10.57) years and the etiology of the ALS was mostly malignant. Technical success was 96.3% (CI95% 93.2–99.4%, I2 = 0%). Clinical success was 95% (CI95% 91.2–98.7%, I2 = 0%) and adverse events (AEs) rate was 6.9% (CI95% 2.9–11.1%, I2 = 0%). Recurrence rate was 16.6% (CI95% 7.7–25.4%, I2 = 43.79%). Subgroup analyses showed differences in the recurrence rate between the use of a fully covered self-expandable metal stent (FCSEMS) (35.9% [CI95% 20.3–51.6%, I2 = 0%]) and a lumen-apposing metal stent (LAMS)(10.4% [CI95% 4–16.8%, I2 = 0%], p = 0.003). Follow-up ranged from a median of 96.5 to 185 days.

Conclusions

EUS-guided GI anastomosis is an effective treatment for ALS, showing high technical and clinical success rates and a low incidence of AEs. The use of LAMS over FCSEMS seems to reduce the recurrence rate, suggesting the routine use of LAMS in the case of EUS-guided GI anastomosis for treating ALS.