BJS 01 Endoscopic Ultrasound–Guided Gastroenterostomy Versus Surgical Gastrojejunostomy for Malignant Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis

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ID: 324084
2026
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Abstract
Abstract Background Patients with malignant gastric outlet obstruction (GOO) require intervention to restore gastric emptying. Surgical gastrojejunostomy (SGJ) is effective but associated with slower recovery and higher complication rates. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative, but comparative evidence remains limited. Methods A systematic review and meta-analysis was conducted including studies comparing EUS-GE and SGJ for malignant GOO. Primary outcomes were technical success, clinical success, and adverse events. Secondary outcomes included procedure duration, time to oral intake, diet tolerance, hospital stay, surgical reintervention, and overall mortality. Pooled analyses were performed using random-effects models, with heterogeneity assessed using I². Results Twelve studies including 22,118 patients (4,954 EUS-GE; 17,164 SGJ) were included. EUS-GE had lower technical success (OR 0.25; p = 0.0002) but higher clinical success (OR 1.51; p = 0.04). EUS-GE was associated with shorter procedure time (–93.8 min; p < 0.0001), earlier oral intake (–2.5 days; p = 0.002), and shorter hospital stay (–4.91 days; p < 0.0001). It required fewer reinterventions (OR 0.39; p = 0.02), had fewer adverse events (OR 0.39; p < 0.0001), and showed lower mortality (OR 0.59; p = 0.05). Diet tolerance was similar between groups. Conclusion Although EUS-GE had lower technical success, likely due to procedural complexity and anatomical challenges, it provides higher clinical success, faster recovery, fewer complications, and reduced need for reintervention compared with SGJ, supporting its role as a safe and effective minimally invasive alternative for malignant GOO.
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Authors Mohamed Abosheisha, Mustafa Alqasem, É. Nasr, Ahmad Asaad, Muhammed Kandeel, Mohamed Ammar Omran, Ahmed Boalot, Maan Sarsam, Ahmed Swealem, Abdulrahman Ismaiel, Mohamed Ismaiel, Jeremy Wilson, Conor Magee
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.004
URL
https://doi.org/10.1093/bjs/znag087.004
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