875 Efficacy and Safety of Endoscopic Ultrasound (EUS) Guided Gastroenterostomy (GE): A Systematic Review and Meta-Analysis : Official journal of the American College of Gastroenterology | ACG

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ABSTRACTS

875 Efficacy and Safety of Endoscopic Ultrasound (EUS) Guided Gastroenterostomy (GE): A Systematic Review and Meta-Analysis

Krishnamoorthi, Rajesh MD1; Jayaraj, Mahendran MD2; Gopalakrishnan Ravikumar, Naveen Prasad MD3; Singh, Dhruv MBBS4; Law, Joanna MD1; Larsen, Michael MD5; Ross, Andrew MD1; Kozarek, Richard MD, FACG5; Irani, Shyan MD1

Author Information

1Digestive Diseases Institute, Virginia Mason Clinic, Seattle, WA;

2University of Nevada Las Vegas School of Medicine, Las Vegas, NV;

3State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY;

4Mayo Clinic, Rochester, MN;

5Virginia Mason Medical Center, Seattle, WA.

The American Journal of Gastroenterology 114():p S507-S508, October 2019. | DOI: 10.14309/01.ajg.0000593036.26785.f3
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Abstract

INTRODUCTION: 

Endoscopic ultrasound (EUS) guided gastroenterostomy (GE) is emerging as an alternative to enteral stenting and surgical GE for management of malignant gastric outlet obstruction (GOO). With advances in EUS technology and availability of dedicated devices/stents for EUS scopes, the use of EUS-GE is expected to increase in the future. We performed a systematic review and meta-analysis to estimate the success rate and adverse events associated with EUS-GE.

METHODS: 

We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, and Web of Science databases (from inception through May 2019) to identify studies that reported success rate and adverse events of EUS-GE. The primary outcome was to estimate the pooled rates of technical and clinical success of EUS-GE. The secondary outcome was to estimate the rate of adverse events.

RESULTS: 

9 studies with a total of 268 patients were included. The pooled rate of technical success of EUS-GE was 91.7 % (95% CI 87.5 – 94.5; I2 = 0). The pooled rate of clinical success of EUS-GJ was 87.8% (95% CI 83.1 – 91.3; I2 = 0). The pooled rate of overall adverse events was 12.6% (95% CI 9.0- 17.6; I2 = 0). The pooled rate of individual adverse events – perforation, bleeding, peritonitis and stent migration / misdeployment were 2% (95% CI 0.7 – 5.1), 3.2% (95% CI 1.5 – 6.5), 2.6% (95% CI 1.1-6.1) and 8.9 % (95% CI 4.3-17.5) respectively.The rate of surgical intervention for adverse events was 2%.

CONCLUSION: 

While the rates of technical success (92%) and clinical success (88%) of EUS-GJ is promising, the risk of adverse events is considerable at 12.6%, with stent misdeployment (9%) being the most common adverse event. Hence, EUS-GJ should be performed at tertiary referral centers in a multidisciplinary (surgery, oncology, gastroenterology) team-based approach.

© 2019 by The American College of Gastroenterology