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Luminal and extraluminal bleeding during EUS-guided double-balloon-occluded gastrojejunostomy bypass in benign gastric outlet obstruction with portal hypertension.

ABSTRACT:

SUBMITTER: Chavan R

PROVIDER: S-EPMC7003061 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis.

Project description:Background and study aims? Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel endoscopic procedure designed to facilitate sustained luminal patency in patients with gastric outlet obstruction. The primary aim of this study was to evaluate the efficacy and safety of EUS-GE for treatment of gastric outlet obstruction. Methods? Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed through April 2019. Patients with benign and malignant gastric outlet obstruction were included. Measured outcomes included: immediate technical and clinical success as well as rate of serious adverse events (AEs). Heterogeneity was assessed with Cochran Q test and I 2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. Results? A total of five studies (n?=?199 patients; 45.73?% male) were included in this study. Four retrospective studies and one prospective study were analyzed. Mean age of patients that underwent the EUS-GE procedure was 64.52?±?1.37 years with a pooled mean follow-up period of 4.32?±?1.65 months. In 21?% of patients (n?=?43), gastric outlet obstruction was due to benign causes. Immediate technical success was 92.90?% (95?% CI; 88.26?-?95.79; I 2 ?=?0.00?%) and reported in all studies. The clinical success rate of EUS-GE was 90.11?% (95?% CI; 84.64?-?93.44; I 2 ?=?0.00?%). Serious AEs occurred in 5.61?% (95?% CI; 2.87?-?10.67; I 2 ?=?1.67?%) of cases and were related to peritonitis, perforation, bleeding, and abdominal pain. Re-intervention rate was 11.43?% (95?% CI; 7.29?-?17.46; I 2 ?=?17.38?%). Conclusions? EUS-GE appears to provide an effective and safe minimally invasive alternative for treatment of benign and malignant gastric outlet obstruction.

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Bezoar formation on percutaneous endoscopic gastrojejunostomy tube causing gastric outlet obstruction and small-intestinal intussusception.

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EUS-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: Systematic review and meta-analysis.

Project description:Background and study aims ?Endoscopic and surgical techniques have been utilized for palliation of gastric outlet obstruction (GOO). Enteral stenting (ES) is an established technique with high clinical success and low morbidity rate. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel approach that aims to provide sustained palliation of GOO. We conducted a comprehensive review and meta-analysis to evaluate the effectiveness in terms of clinical and technical success, as well as the safety profile of EUS-GE and ES. Methods ?We searched multiple databases from inception through July 2020 to identify studies that reported on safety and effectiveness of EUS-GE in comparison to ES.?Pooled rates of technical success, clinical success, and adverse events (AEs) were calculated. Study heterogeneity was assessed using I 2 % and 95?% confidence interval. Results ?Five studies including 659 patients were included in our final analysis. Pooled rate of technical and clinical success for EUS-GE was 95.2?% (CI 87.2-.98.3, I 2 ?=?42) and 93.3?% (CI 84.4-97.3, I 2 ?=?59) while for ES it was 96.9?% (CI 90.9-99, I 2 ?=?64) and 85.6?% (CI 73-92.9, I 2 ?=?85), respectively. Pooled rate of re-intervention was significantly lower with EUS-GE i.?e. 4?% (CI 1.8-8.7, I 2 ?=?35) compared to ES, where it was 23.6?% (CI 17.5-31, I 2 ?=?35), p?=?0.001 . Pooled rates of overall and major AEs were comparable between the two techniques. Conclusion ?EUS-GE is comparable in terms of technical and clinical effectiveness and has a similar safety profile when compared to ES for palliation of GOO.

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Endoscopic ultrasound-guided gastroenterostomy versus surgical gastrojejunostomy in treatment of malignant gastric outlet obstruction: Systematic review and meta-analysis.

Project description:Background and study aims Palliative treatment of malignant gastric outlet obstruction (GOO) has conventionally been with surgical gastrojejunostomy (SGJ). Advent of devices like lumen apposing metal stents has made endoscopic ultrasound-guided gastroenterostomy (EUS-GE) a potential alternative to SGJ for these patients. We performed a systematic review and meta-analysis of studies that compared outcomes of EUS-GE versus SGJ. Methods We performed a comprehensive systematic search of multiple electronic databases and conference proceedings through January 2021 and identified six studies that compared outcomes of EUS-GE versus SGJ in the management of malignant GOO. The rates of technical success, clinical success, and AEs were analyzed, and pooled odds ratios were calculated using random effects model. Results Six studies were included in our analysis with a total of 484 patients, of which 291 underwent EUS-GE and 193 underwent SGJ. The technical success rate of SGJ was superior to EUS-GE (OR = 0.195; 95 %CI:0.054-0.702; P = 0.012; I 2 = 0). The clinical success of EUS-GE was statistically similar to SGJ (OR = 1.566; 95 %CI:0.585-4.197; P = 0.372; I 2 = 46.68 %). EUS-GE had significantly fewer AEs compared to SGJ (OR = 0.295; 95 %CI:0.172-0.506; P < 0.005; I 2 = 0). Among studies which reported reintervention rates, EUS-GE was statistically similar to SGJ (OR = 0.587; 95 %CI:0.174-1.979; P = 0.390, I 2 = 54.91). Minimal to moderate heterogeneity was noted in the analyses. Conclusions EUS-GE has equivalent clinical success and reintervention rates, but significantly lower adverse events compared to SGJ. When feasible, EUS-GE appears to be an effective and safe alternative to SGJ for palliative management of malignant GOO.

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EUS-guided gastroenterostomy versus surgical gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis.

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