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Background <p>Malignant gastric outlet obstruction (MGOO) is a disabling complication of advanced gastrointestinal cancers, accounting for 50–80% of gastric outlet obstruction cases. As patients have unresectable disease, management is palliative and traditionally relies on surgical gastrojejunostomy (SGJ) or enteral stenting, both with limitations. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emerged, but its role remains uncertain. We conducted a systematic review and meta-analysis comparing EUS-GE with SGJ and enteral stenting.</p> Methods <p>Pubmed, Embase, Scopus, and Cochrane were searched for eligible studies. Mean differences (MDs) and risk ratio (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was examined with <i>I</i><sup>2</sup> statistics and trial sequential analysis evaluated the cumulative evidence. Prespecified subgroup analyses were conducted for randomized controlled trials and propensity score-matched studies. Statistical analyses were performed using RStudio.</p> Results <p>Twenty-two studies were included, comprising 22,211 and 1,479 patients in the EUS-GE vs SGJ and EUS-GE vs enteral stenting analysis, respectively. EUS-GE was associated with fewer infections (RR 0.46; <i>p</i> = 0.0137), overall postoperative complications (RR 0.38; <i>p</i> &lt; 0.0001), including both major (RR 0.43; <i>p</i> = 0.0109) and minor complications (RR 0.35; <i>p</i> &lt; 0.0001), and a reduced need for reintervention (RR 0.15; <i>p</i> &lt; 0.0001) than SGJ, as well as higher clinical success (RR 1.11; <i>p</i> = 0.0003) compared with enteral stenting. SGJ showed higher technical success (RR 0.98; <i>p</i> = 0.0003).</p> Conclusion <p>EUS-GE offers a safe and effective minimally invasive alternative for MGOO. Its growing evidence base supports its consideration as a preferred option in centers with appropriate expertise.</p> Graphical Abstract <p></p>

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Endoscopic ultrasonography-guided gastroenterostomy versus conventional approaches for cancer-related malignant gastrointestinal outlet obstruction: a meta-analysis with trial sequential analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月12日

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  • Ana Luíza Rocha Soares Menegat,
  • Brenda Luana Rocha Soares Menegat,
  • Clara Rocha Dantas,
  • Barbara Antonia Dups Talah,
  • Francisco Cezar Aquino de Moraes

摘要

Background

Malignant gastric outlet obstruction (MGOO) is a disabling complication of advanced gastrointestinal cancers, accounting for 50–80% of gastric outlet obstruction cases. As patients have unresectable disease, management is palliative and traditionally relies on surgical gastrojejunostomy (SGJ) or enteral stenting, both with limitations. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emerged, but its role remains uncertain. We conducted a systematic review and meta-analysis comparing EUS-GE with SGJ and enteral stenting.

Methods

Pubmed, Embase, Scopus, and Cochrane were searched for eligible studies. Mean differences (MDs) and risk ratio (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was examined with I2 statistics and trial sequential analysis evaluated the cumulative evidence. Prespecified subgroup analyses were conducted for randomized controlled trials and propensity score-matched studies. Statistical analyses were performed using RStudio.

Results

Twenty-two studies were included, comprising 22,211 and 1,479 patients in the EUS-GE vs SGJ and EUS-GE vs enteral stenting analysis, respectively. EUS-GE was associated with fewer infections (RR 0.46; p = 0.0137), overall postoperative complications (RR 0.38; p < 0.0001), including both major (RR 0.43; p = 0.0109) and minor complications (RR 0.35; p < 0.0001), and a reduced need for reintervention (RR 0.15; p < 0.0001) than SGJ, as well as higher clinical success (RR 1.11; p = 0.0003) compared with enteral stenting. SGJ showed higher technical success (RR 0.98; p = 0.0003).

Conclusion

EUS-GE offers a safe and effective minimally invasive alternative for MGOO. Its growing evidence base supports its consideration as a preferred option in centers with appropriate expertise.

Graphical Abstract