P1066 - EUS-Guided Gastroenterostomy for Benign Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis

Andrew Canakis, DO¹, Nicol Tugarinov, BS², Jay Bapaye, MD³, Benjamin Twery, MD², Justin Canakis, DO⁴, Abdulhameed Al-Sabban, MD⁵, Shayan Irani, MD^6
1University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; ²University of Maryland School of Medicine, Baltimore, MD; ³Virginia Tech Carilion School of Medicine, Roanoke, VA; ⁴Penn State Health Milton S. Hershey Medical Center, Hershey, PA; ⁵University of Maryland Medical Center, Baltimore, MD; ⁶Virginia Mason Franciscan Health, Seattle, WA

Introduction: Gastric outlet obstruction (GOO) is a clinical manifestation of obstruction at the antropyloric region or proximal small bowel that can lead to progressive symptoms of nausea, vomiting, weight loss, volume depletion and malnutrition. The degree of mechanical blockage correlates with symptom severity. The goal of endoscopic management is to relieve the obstruction so individuals can resume per oral intake and thus improve quality of life metrics.

Most studies have involved malignant causes of GOO; yet only a handful of studies have explored outcomes related to benign etiologies. Management options for benign GOO includes endoscopic balloon dilation, fully covered self-expanding metal stent placement, and lumen apposing metal stent (LAMS) placement across the stricture. Recently, endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a novel method to bypass the obstruction with a LAMS. In this systematic review and meta-analysis, we aim to explore the technical success and clinical outcomes of EUS-GE for benign GOO.

Methods: Multiple databases were searched for studies looking at EUS-GE for benign GOO from inception until May 2024. The primary outcome was technical and clinical success. Secondary outcomes included rate of reintervention and adverse events (AE).

Results: Nine studies met inclusion criteria with 150 patients treated with EUS-GE for benign GOO (Table 1). The most common etiologies were from chronic (n=48) and acute (n=41) pancreatitis. The direct technique was utilized in most cases (n=80), and the mean procedure time was 51.2 minutes.

The pooled technical success rate was 95.5% (95% confidence interval (CI), 91.27-98.17; I2 = 0%) and clinical success rate was 91% (95% CI, 82.66-95.5; I2 = 0%) (Figure 1). The rates of reintervention and AE were 9.27% (95% CI, 3.92-20.39; I2 = 42%) and 7.63% (95% CI, 3.78-14.8; I2 = 0%), respectively.

Discussion: The results of this meta-analysis demonstrate the efficacy and relative safety profile of EUS-GE for benign GOO. Further comparative studies are needed to determine the optimal treatment strategy in this select patient population based on the underlying etiology and treatment modality (i.e. enteral stenting).



Disclosures:


Andrew Canakis, DO¹, Nicol Tugarinov, BS², Jay Bapaye, MD³, Benjamin Twery, MD², Justin Canakis, DO⁴, Abdulhameed Al-Sabban, MD⁵, Shayan Irani, MD⁶. P1066 - EUS-Guided Gastroenterostomy for Benign Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.