Clinical Efficacy of Endoscopic Ultrasound-Guided Gastroenterostomy, Enteral Stenting, and Surgical Gastrojejunostomy for Malignant Gastric Outlet Obstruction: A Network Meta-Analysis
In brief
Endoscopic ultrasound gastroenterostomy reduces repeat interventions by about 80% compared with stenting
In a network meta-analysis of 1,585 patients with malignant gastric outlet obstruction, EUS-guided gastroenterostomy lowered the need for re-intervention to roughly one-sixth of that seen with enteral stents and improved clinical success rates over both stents and surgical gastrojejunostomy. It also shortened hospital stay and time to oral intake, though results come mainly from expert centers and need broader validation.
- Journal
- Gastrointestinal endoscopy (Q1)
- Published
- 3 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yu-Ning Peng, Ghina Faucher-Jabado, Amine Benmassaoud, Myriam Martel, Said Al Alawi, Nicolas Chapelle, et al.
- PMID
- 42546781
- DOI
- 10.1016/j.gie.2026.07.038
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 9 August 2026): Network meta‑analysis of EUS‑GE, stenting, and surgery for malignant GOO
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 9 August 2026): High-quality evidence in a top journal
- Picked for Epidemiology (top studies of the week, 9 August 2026).
- Picked for Surgery (top studies of the week, 9 August 2026): Network meta‑analysis of EUS‑GE, enteral stenting, and surgical gastrojejunostomy for
Abstract
BACKGROUND AND AIMS: Treatment options for malignant gastric outlet obstruction (MGOO) include endoscopic ultrasound-guided gastroenterostomy (EUS-GE), enteral stenting (ES), and surgical gastrojejunostomy (SGJ). We aim to provide a comprehensive comparative assessment of these interventions. METHODS: We performed a systematic review and Bayesian network meta-analysis (NMA) of RCTs and cohort studies with causal adjustment comparing EUS-GE to ES, EUS-GE to SGJ, or SGJ to ES for MGOO (CRD420251133918). We searched PubMed, Embase, and Web of Science. Outcomes included re-intervention, clinical success, adverse events, length of hospitalization, time to oral intake, and technical success. Transitivity was assessed by comparing key effect modifiers, and consistency through Bayesian node-splitting. Sensitivity analysis restricted to RCTs only. RESULTS: Six RCTs and ten causally adjusted cohort studies involving 1585 patients (376 EUS-GE, 726 ES, and 483 SGJ) were included. Baseline characteristics were comparable. EUS-GE demonstrated lower re-intervention rates than ES [risk ratio (RR) = 0.17; 95% credible interval (CrI), 0.07-0.35) and SGJ (RR = 0.3; 95% CrI, 0.11-0.65). Clinical success was higher with EUS-GE compared with ES (RR = 1.20; 95% CrI, 1.13-1.29) and SGJ (RR = 1.17; 95% CrI, 1.10-1.26). EUS-GE also shortened length of hospitalization (MD = -6.00; 95% CrI, -8.38 to -3.14) and time to oral intake (MD = -2.18; 95% CrI, -3.93 to -0.63) compared with SGJ. Based on direct pairwise comparisons, technical success did not differ among the three groups; however, network meta-analysis showed a higher technical success rate for SGJ compared with ES and EUS-GE. SUCRA rankings favored EUS-GE across most outcomes (re-intervention, clinical success, adverse events, length of hospitalization, and time to oral intake). Only minor inconsistency was detected, and sensitivity analyses were consistent with the primary analysis. CONCLUSIONS: EUS-GE is associated with better clinical outcomes to ES and SGJ for MGOO. Future studies are needed to evaluate outcomes outside expert centers.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.