PMID- 36540454
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231103
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 11
DP  - 2022 Nov
TI  - Endoscopic Ultrasound-Guided Gastroenterostomy for the Palliation of Gastric 
      Outlet Obstruction (GOO): A Systematic Review and Meta-analysis of the Different 
      Techniques.
PG  - e31526
LID - 10.7759/cureus.31526 [doi]
LID - e31526
AB  - INTRODUCTION: Gastric outlet obstruction (GOO) is usually associated with a poor 
      prognosis and a significant decrease in a patient's quality of life. Endoscopic 
      ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents 
      (LAMS) has emerged as a safe and effective palliation procedure for GOO in 
      patients that are unfit for surgery. Without an exclusive gold-standard technique 
      for EUS-GE, we aimed to compare the currently available ones in this systematic 
      review and meta-analysis, the first on this subspecialty. METHODS: A 
      comprehensive search from multiple electronic databases was performed. The search 
      had a particular emphasis on the techniques used in performing EUS-GE. We 
      identified all the studies in which EUS-GE was performed as palliation for GOO 
      from its inception to the current date. The outcomes analyzed were the following: 
      technical and clinical success, total and severe adverse events (AEs), procedure 
      duration, and length of hospital stay (LOHS). RESULTS: Twenty studies involving 
      863 patients were the basis of this statistical analysis. Patients underwent the 
      following techniques: direct gastroenterostomy (DGE) (n=718), balloon-assisted 
      gastroenterostomy (BAGE) (n=27), and endoscopic ultrasound (EUS)-guided 
      double-balloon-occluded gastrojejunostomy bypass (n=118). In comparison to 
      balloon-assisted techniques, DGE had a lower rate of AEs, -0.121 (95% CI -0.191 
      to -0.051 p=0.001); and LOHS for the DGE group, -2.684 (95% CI -1.031 to -4.337 
      p=0.001). The other analyzed outcomes presented no statistically significant 
      differences. On a sub-analysis, BAGE showed a lower rate of AEs than EUS-guided 
      double-balloon-occluded gastrojejunostomy bypass, -0.196 (95% CI -0.061 to -0.331 
      p=0.004). CONCLUSIONS: EUS-GE is a safe and effective procedure for 
      palliating GOO. When correctly administered, any of the analyzed techniques may 
      be used to palliate GOO with similar technical and clinical outcomes. DGE had 
      significantly lower rates of AEs and LOHS, which can be inferred as a safer 
      procedure. These results should be interpreted cautiously due to the limited few 
      studies that are available and accessible. Therefore, further well-designed, 
      randomized clinical studies on the topic are warranted to compare the different 
      techniques from more sources.
CI  - Copyright (c) 2022, Ribas et al.
FAU - Ribas, Pedro Henrique Boraschi V
AU  - Ribas PHBV
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
FAU - De Moura, Diogo Turiani H
AU  - De Moura DTH
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
FAU - Proenca, Igor M
AU  - Proenca IM
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
FAU - Do Monte Junior, Epifanio S
AU  - Do Monte Junior ES
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
FAU - Yvamoto, Erika Y
AU  - Yvamoto EY
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
FAU - Hemerly, Matheus C
AU  - Hemerly MC
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
FAU - De Oliveira, Victor L
AU  - De Oliveira VL
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
FAU - Ribeiro, Igor B
AU  - Ribeiro IB
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
FAU - Sanchez-Luna, Sergio A
AU  - Sanchez-Luna SA
AD  - Gastroenterology, University of Alabama at Birmingham Marnix E. Heersink School 
      of Medicine, Birmingham, USA.
FAU - Bernardo, Wanderley M
AU  - Bernardo WM
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
FAU - De Moura, Eduardo Guimaraes H
AU  - De Moura EGH
AD  - Gastroenterology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, 
      Universidade de Sao Paulo, Sao Paulo, BRA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20221115
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9754671
OTO - NOTNLM
OT  - endoscopic ultrasound (eus)
OT  - eus-ge
OT  - gastric outlet obstruction
OT  - goo
OT  - lams
OT  - lumen apposing metal stent
OT  - palliation
OT  - palliative care
COIS- The authors have declared financial relationships, which are detailed in the next 
      section.
EDAT- 2022/12/22 06:00
MHDA- 2022/12/22 06:01
PMCR- 2022/11/15
CRDT- 2022/12/21 02:10
PHST- 2022/11/14 00:00 [accepted]
PHST- 2022/12/21 02:10 [entrez]
PHST- 2022/12/22 06:00 [pubmed]
PHST- 2022/12/22 06:01 [medline]
PHST- 2022/11/15 00:00 [pmc-release]
AID - 10.7759/cureus.31526 [doi]
PST - epublish
SO  - Cureus. 2022 Nov 15;14(11):e31526. doi: 10.7759/cureus.31526. eCollection 2022 
      Nov.