Muhammad Asghar, David Forcione, Srinivas Reddy Puli
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The outcomes of technical success, clinical success, and adverse events (AEs) were evaluated. Pooled proportions were calculated using both fixed and random effects models.</p><p><strong>Results: </strong>We included 13 studies with 1762 patients in our final analysis. The pooled rates of technical success for EUS-GE were 95.59% [95% confidence interval (CI), 94.01-97.44, <i>I</i> <sup>2</sup> = 32] and 97.96% (95% CI, 96.06-99.25, <i>I</i> <sup>2</sup> = 63) for ES. The pooled rate of clinical success for EUS-GE was 93.62% (95% CI, 90.76-95.98, <i>I</i> <sup>2</sup> = 54) while for ES it was lower at 85.57% (95% CI, 79.63-90.63, <i>I</i> <sup>2</sup> = 81). The pooled odds ratio (OR) of clinical success was higher for EUS-GE compared to ES at 2.71 (95% CI, 1.87-3.93). The pooled OR of clinical success for EUS-GE was higher compared to ES at 2.72 (95% CI, 1.86-3.97, <i>I</i> <sup>2</sup> = 0). The pooled rates of re-intervention for EUS-GE were lower at 3.77% (95% CI, 1.77-6.46, <i>I</i> <sup>2</sup> = 44) compared with ES, which was 25.13% (95% CI, 18.96-31.85, <i>I</i> <sup>2</sup> = 69). The pooled OR of the rate of re-intervention in the ES group was higher at 7.96 (95% CI, 4.41-14.38, <i>I</i> <sup>2</sup> = 13). Overall, the pooled rate for AEs for EUS-GE was 8.97% (95% CI, 6.88-11.30, <i>I</i> <sup>2</sup> = 15), whereas that for ES was 19.63% (95% CI, 11.75-28.94, <i>I</i> <sup>2</sup> = 89).</p><p><strong>Conclusion: </strong>EUS-GE and ES are comparable in terms of their technical effectiveness. However, EUS-GE has demonstrated improved clinical effectiveness, a lower need for re-intervention, and a better safety profile compared to ES for palliation of gastric outlet obstruction.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11159541/pdf/","citationCount":"0","resultStr":"{\"title\":\"Endoscopic ultrasound-guided gastroenterostomy <i>versus</i> enteral stenting for gastric outlet obstruction: a systematic review and meta-analysis.\",\"authors\":\"Muhammad Asghar, David Forcione, Srinivas Reddy Puli\",\"doi\":\"10.1177/17562848241248219\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The symptoms of gastric outlet obstruction have traditionally been managed surgically or endoscopically. 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The pooled rates of technical success for EUS-GE were 95.59% [95% confidence interval (CI), 94.01-97.44, <i>I</i> <sup>2</sup> = 32] and 97.96% (95% CI, 96.06-99.25, <i>I</i> <sup>2</sup> = 63) for ES. The pooled rate of clinical success for EUS-GE was 93.62% (95% CI, 90.76-95.98, <i>I</i> <sup>2</sup> = 54) while for ES it was lower at 85.57% (95% CI, 79.63-90.63, <i>I</i> <sup>2</sup> = 81). The pooled odds ratio (OR) of clinical success was higher for EUS-GE compared to ES at 2.71 (95% CI, 1.87-3.93). The pooled OR of clinical success for EUS-GE was higher compared to ES at 2.72 (95% CI, 1.86-3.97, <i>I</i> <sup>2</sup> = 0). The pooled rates of re-intervention for EUS-GE were lower at 3.77% (95% CI, 1.77-6.46, <i>I</i> <sup>2</sup> = 44) compared with ES, which was 25.13% (95% CI, 18.96-31.85, <i>I</i> <sup>2</sup> = 69). The pooled OR of the rate of re-intervention in the ES group was higher at 7.96 (95% CI, 4.41-14.38, <i>I</i> <sup>2</sup> = 13). 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引用次数: 0
摘要
背景：传统上，胃出口梗阻的症状可通过手术或内镜进行治疗。胃肠道支架植入术（ES）是一种创伤较小的内镜治疗方法。最近，内镜超声引导胃肠造口术（EUS-GE）已成为一种潜在的替代技术：我们对 EUS-GE 与 ES 相比的有效性和安全性进行了系统回顾和荟萃分析：荟萃分析和系统综述：我们检索了从开始到 2023 年 8 月的多个数据库，以确定报道 EUS-GE 与 ES 相比的有效性和安全性的研究。对技术成功率、临床成功率和不良事件（AEs）等结果进行了评估。采用固定效应和随机效应模型计算汇总比例：我们在最终分析中纳入了 13 项研究，共 1762 名患者。EUS-GE 的汇总技术成功率为 95.59% [95% 置信区间 (CI)，94.01-97.44，I 2 = 32]，ES 为 97.96%（95% CI，96.06-99.25，I 2 = 63）。EUS-GE 的汇总临床成功率为 93.62%（95% CI，90.76-95.98，I 2 = 54），而 ES 的临床成功率较低，为 85.57%（95% CI，79.63-90.63，I 2 = 81）。与 ES 相比，EUS-GE 临床成功的汇总赔率（OR）更高，为 2.71（95% CI，1.87-3.93）。与 ES 相比，EUS-GE 临床成功的汇总 OR 为 2.72（95% CI，1.86-3.97，I 2 = 0）。EUS-GE 的再干预率为 3.77%（95% CI，1.77-6.46，I 2 = 44），低于 ES 的 25.13%（95% CI，18.96-31.85，I 2 = 69）。ES 组再次干预率的汇总 OR 值较高，为 7.96（95% CI，4.41-14.38，I 2 = 13）。总体而言，EUS-GE的AEs汇总率为8.97%（95% CI，6.88-11.30，I 2 = 15），而ES的AEs汇总率为19.63%（95% CI，11.75-28.94，I 2 = 89）：结论：就技术效果而言，EUS-GE 和 ES 具有可比性。结论：就技术效果而言，EUS-GE 和 ES 具有可比性，但在缓解胃出口梗阻方面，EUS-GE 的临床效果更好，再次介入治疗的需求更低，安全性也优于 ES。
Endoscopic ultrasound-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: a systematic review and meta-analysis.
Background: The symptoms of gastric outlet obstruction have traditionally been managed surgically or endoscopically. Enteral stenting (ES) is a less invasive endoscopic treatment strategy for this condition. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently become a potential alternative technique.
Objectives: We conducted a systematic review and meta-analysis of the effectiveness and safety profile of EUS-GE compared with ES.
Design: Meta-analysis and systematic review.
Data sources and methods: We searched multiple databases from inception to August 2023 to identify studies that reported the effectiveness and safety of EUS-GE compared with ES. The outcomes of technical success, clinical success, and adverse events (AEs) were evaluated. Pooled proportions were calculated using both fixed and random effects models.
Results: We included 13 studies with 1762 patients in our final analysis. The pooled rates of technical success for EUS-GE were 95.59% [95% confidence interval (CI), 94.01-97.44, I2 = 32] and 97.96% (95% CI, 96.06-99.25, I2 = 63) for ES. The pooled rate of clinical success for EUS-GE was 93.62% (95% CI, 90.76-95.98, I2 = 54) while for ES it was lower at 85.57% (95% CI, 79.63-90.63, I2 = 81). The pooled odds ratio (OR) of clinical success was higher for EUS-GE compared to ES at 2.71 (95% CI, 1.87-3.93). The pooled OR of clinical success for EUS-GE was higher compared to ES at 2.72 (95% CI, 1.86-3.97, I2 = 0). The pooled rates of re-intervention for EUS-GE were lower at 3.77% (95% CI, 1.77-6.46, I2 = 44) compared with ES, which was 25.13% (95% CI, 18.96-31.85, I2 = 69). The pooled OR of the rate of re-intervention in the ES group was higher at 7.96 (95% CI, 4.41-14.38, I2 = 13). Overall, the pooled rate for AEs for EUS-GE was 8.97% (95% CI, 6.88-11.30, I2 = 15), whereas that for ES was 19.63% (95% CI, 11.75-28.94, I2 = 89).
Conclusion: EUS-GE and ES are comparable in terms of their technical effectiveness. However, EUS-GE has demonstrated improved clinical effectiveness, a lower need for re-intervention, and a better safety profile compared to ES for palliation of gastric outlet obstruction.
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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