Bayesian network meta-analysis comparing efficacy of surgical gastrojejunostomy, endoscopic stenting, and EUS-guided gastroenterostomy for malignant gastric outlet obstruction
In brief
Ultrasound-guided endoscopic bypass had 38% higher clinical success than surgery
In a network analysis of 15 studies and 827 patients, ultrasound-guided endoscopic bypass had higher clinical success than surgical bypass, while stenting also outperformed surgery. Stenting led to more repeat procedures than either alternative, and both endoscopic approaches shortened time to eating and hospital stay. Safety and survival did not differ significantly, and direct randomized comparisons are still needed.
- Journal
- Surgical endoscopy (Q1)
- Published
- 16 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Zhixin Xie, Zhiyu Yan, Yunlu Feng, Aiming Yang, Wen Shi, Qiang Wang
- PMID
- 42886244
- DOI
- 10.1007/s00464-026-13468-z
Why clinicians should know about it
- Picked for Surgery (top studies of the week, 18 October 2026): Thoracoscopic vs endoscopic esophageal leiomyoma resection
Abstract
BACKGROUND AND AIMS: Malignant gastric outlet obstruction (GOO) substantially impairs quality of life in patients with advanced malignancies. Surgical gastrojejunostomy (S-GJ), endoscopic stenting (ES), and EUS-guided gastroenterostomy (EUS-GE) are the principal palliative options. We performed a Bayesian network meta-analysis to compare their efficacy and safety. METHODS: PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched through April 13, 2026. Randomized controlled trials and eligible comparative cohort studies comparing at least two interventions in adults with malignant GOO were included. Bayesian network meta-analysis was performed, and treatments were ranked using the surface under the cumulative ranking curve (SUCRA). RESULTS: Fifteen studies (7 RCTs and 8 cohort studies; 827 patients) were included. EUS-GE achieved higher clinical success than S-GJ (risk ratio [RR] 1.38, 95% credible interval [CrI] 1.15-1.88; SUCRA 0.98), and ES was also superior to S-GJ (RR 1.18, 95% CrI 1.01-1.49). Reintervention was more frequent with ES than with S-GJ (RR 3.61, 95% CrI 1.43-14.51) or EUS-GE (RR 7.56, 95% CrI 2.02-38.14), whereas EUS-GE ranked highest for durability (SUCRA 0.93). Both endoscopic approaches shortened time to oral intake and hospital stay compared with S-GJ. No statistically significant between-treatment differences were identified for adverse events, 30-day mortality, or overall survival. CONCLUSIONS: EUS-GE was associated with a favorable balance of efficacy, durability, and recovery and may represent a promising minimally invasive alternative in centers with appropriate expertise. ES provides rapid recovery but is associated with more frequent reintervention, whereas S-GJ remains an established option. Additional direct randomized comparisons are needed to define the optimal palliative strategy.
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.