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Monday Poster Session

Category: Interventional Endoscopy

P1714 - Comparison of Endoscopic Ultrasound-Guided Gastroenterostomy to Surgical Gastroenterostomy for the Management of Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Anand Kumar, MD

Lenox Hill Hospital, Northwell Health
New York, NY, United States

Anand Kumar, MD¹, Saurabh Chandan, MD², Babu Mohan, MD³, Pradeep Atla, MD, MPH⁴, Evin McCabe, MD⁵, David Robbins, MD¹, Arvind J. Trindade, MD⁶, Petros Benias, MD⁵
¹Lenox Hill Hospital, Northwell Health, New York, NY; ²Creighton University School of Medicine, Omaha, NE; ³University of Utah School of Medicine, Salt Lake City, UT; ⁴Palmdale Regional Medical Center, Palmdale, CA; ⁵Lenox Hill Hospital, New York, NY; ⁶Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY

Introduction: Surgical gastroenterostomy (SGE) has been the mainstay treatment for gastric outlet obstruction (GOO). The emergence of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) presents a less invasive alternative for palliation of GOO. We conducted a comprehensive review and meta-analysis to compare the effectiveness and safety profile of EUS-GE compared to SGE.

Methods: Multiple electronic databases and conference proceedings up to April 2021 were searched to identify studies that reported on safety and effectiveness of EUS-GE in comparison to SGE. Pooled odds ratios (OR) of technical success, clinical success, adverse events and recurrence, and pooled standardized mean difference (SMD) of procedure time and post-procedure length of stay were calculated. Study heterogeneity was assessed using I²%.

Results: Seven studies including 625 patients (372 EUS-GE and 253 SGE) were included (Table 1: study population characteristics). EUS-GE had lower pooled odds of technical success compared with SGE (OR 0.19, 95% CI 0.06-0.60, I² 0%). Among the technically successful cases, EUS-GE was superior in terms of clinical success (OR 4.73, 95% CI 1.83-12.25, I² 18%), lower overall adverse events (OR 0.21, 95% CI 0.11-0.41, I² 41%), and shorter procedure time (SMD -2.4, 95% CI -4.1, -0.75, I² 95%) and post-procedure length of stay (SMD -0.49, 95% CI -0.94, -0.03, I² 78%). Rates of severe adverse events (OR 0.98, 95% CI 0.11-8.41, I² 68%) and recurrence (OR 0.49, 95% CI 0.18-1.38, I² 49%) were comparable (Figure 1: Forest plots of study outcomes)

Discussion: Our results suggest EUS-GE is a promising alternative to SGE due to its superior clinical success, overall safety, and efficiency. With further evolution EUS-GE could become the palliative intervention of choice in GOO. To our knowledge this is the most up-to-date systematic review and meta-analysis of available studies on this topic within a large cohort of patients with GOO.

Figure: Forest Plots of Study Outcomes

Study, year

Design, data collection period

Etiology of GOO

(M=malignant, B=benign)

Type of malignancy

(gastric=1, duodenal=2, ampullary=3,

pancreatic=4, biliary=5, others=6

EUS-GE technique (DP=direct puncture, AT=assisted)/

stent type

SGE technique (O=open, L=laparoscopic)

Prior interventions; Altered anatomy

Total patients

Gender (male)

Age (years) [mean (SD) unless specified]

EUS-GE

SGE

EUS-GE

SGE

EUS-GE

SGE

Perez-Miranda, 2017

Retrospective, multicenter, Mar 2014 to Nov 2015

M=46/54, B=8/54

DP=6, AT=19; Axios (hot 12, cold 13)

O=2, L=27

EUS-GE: 18, SGE: 0; EUS-GE: 7, SGE: 0

11/25

22/29

63.9

75.8

Khashab, 2017

Retrospective, multicenter, Jan 2013 to Aug 2015

M=93, B=0

EUS-GE: G 5, A 2, P 17, B 2, O 4; SGE: A 9, D 1, P 53

DP=2, AT= 28; Axios (hot 21, cold 7), Niti-S Spaxus 2

O=63, L=0

17/30

32/63

70 (13.3)

(9.6)

Widmer, 2019 (abs)

Retrospective, single-center, Jan 15 to Nov 18

M=24, B=0

EUS: P 4, D 1, G 1, O 3; SGE: P 4, D 3, G 1, A 1, B 2, O 2.

DP=6, AT= 4; S; Axios (hot) 10

O=11, L=3

5/10

5/14

63 (range 40-94)

(range 47-86)

Marya, 2020 (abs)

Retrospective, multicenter, Jun 2005 to Nov 2019

EUS-GE: M=137, B=34; SGE: M=24, B=15

EUS-GE: 22, SGE: 21; EUS-GE: 8, SGE: 8

172

104/172

20/39

62.4 (11.8)

63.9 (13.7)

Bondi, 2020 (abs)

Retrospective, single-center, 2000 to 2019

M=52, B=0

EUS-GE: G 2, D 1, P 4, B 5, O 6; SGE: G 8, D 4, P 11, B 1, O 10

NR; Axios (hot) 18

8/18

16/34

(11)

61.3 (14)

Kouanda, 2021

Retrospective, single-center, Jan 2014- Feb 2020

M=50, B=16

EUS-GE: P 26, B 3, G 0, D 1, A 1, O 5; SGE: P 3, B 1, G 8, D 1, A 0, O 1

DP=40, AT=0; NR

O=26, L=0

EUS-GE: 9, SGE: 7; NR

23/40

15/26

70.5 (11.5)

69.7

(15.4)

Bronswijk, 2021

Retrospective, multi-center, Jan 2015 to May 2020

EUS-GE: 74; SGE: 41

EUS-GE: P 37, B 9, G 7, D 11, A 0, O 8 ; SGE: P 14, B 2, G 5, D 10, A 1, O 4

DP=77, AT=0; Axios (hot) 77

O=0, L=48

41/77

29/48

65 (12.3)

66 (11.6)

EUS-GE: endoscopic ultrasound guided gastroenterostomy; NR: not reported, SD: standard deviation, SGE: surgical gastroenterostomy

Table: Table 1: Study population characteristics

Disclosures:

Anand Kumar indicated no relevant financial relationships.

Saurabh Chandan indicated no relevant financial relationships.

Babu Mohan indicated no relevant financial relationships.

Pradeep Atla indicated no relevant financial relationships.

Evin McCabe indicated no relevant financial relationships.

David Robbins indicated no relevant financial relationships.

Arvind Trindade: NinePoint Medical – Grant/Research Support. Olympus America – Consultant. Pentax Medical – Consultant.

Petros Benias indicated no relevant financial relationships.

Anand Kumar, MD¹, Saurabh Chandan, MD², Babu Mohan, MD³, Pradeep Atla, MD, MPH⁴, Evin McCabe, MD⁵, David Robbins, MD¹, Arvind J. Trindade, MD⁶, Petros Benias, MD⁵. P1714 - Comparison of Endoscopic Ultrasound-Guided Gastroenterostomy to Surgical Gastroenterostomy for the Management of Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.