The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e2 

EUS Guided Gastroenterostomy Vs 
Surgical Gastrojejunostomy for the 
Palliation of Malignant Gastric Outlet 
Obstruction: A Systemic Review and Meta-
analysis 
Wasef Sayeh1*, Azizullah Beran, MD1, Sami Ghazaleh, MD1, Amna Iqbal, MD1, 
Justin Chuang, Mohammad Safi, MD1, Saif-Eddin Malhas, MD1, Ziad Abuhelwa, 
MD1, Waleed Kokher, MD1, Omar Sajdeya, MD1, Muhammad Aziz, MD2, Ajit 
Ramadugu, MD2, Ali Nawras, MD2

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: wasef.sayeh@utoledo.edu

Published: 05 May 2023 

Background: Gastric Outlet Obstruction (GOO) was traditionally treated palliatively with surgical 
gastrojejunostomy (SGJ). However, very few studies were done on less aggressive procedures including 
EUS guided gastroenterostomy (EUS-GE). 

Methods: We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and 
the Cochrane Central Register of Controlled Trials from inception through October 10, 2021. We 
considered only randomized controlled trials. The primary outcome was the technical success. The 
secondary outcomes were the occurrence of adverse events and the 30 days mortality rate. The random-
effects model was used to calculate the risk ratios (RR), mean differences (MD), and confidence 
intervals (CI). A p value <0.05 was considered statistically significant.  

Results: Four randomized controlled trials involving 271 patients were included in the meta-analysis. 
The rate of the technical success was significantly lower in the EUS-GE compared to the SGJ (91.4% vs. 
100%, RR 0.92, 95% CI 0.87 – 0.98, p =0.001, I2 = 0%). However, no statistical significance was noted 
in the rate of adverse events and the 30 days mortality rate between the two groups (11.7% vs 10.4%, 
RR 0.90, 95% CI 0.20 – 4.10, p =0.89, I2 = 59%) and (4.6% vs. 1.4%, RR 1.61, 95% CI 0.31 – 8.31, p 
=0.57, I2 = 0%).  

https://dx.doi.org/10.46570/utjms.vol11-2023-680 

https://dx.doi.org/10.46570/utjms.vol11-2023-680
mailto:wasef.sayeh@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-680 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-680 2 ©2023 UTJMS 

Conclusion: Our meta-analysis demonstrated that the technical success was significantly higher in the 
SGJ compared to the EUS-GE. However, there was no significant difference between the two groups in 
the rates of clinical success, 30 days mortality rate and the rate of adverse events. 

https://dx.doi.org/10.46570/utjms.vol11-2023-680
https://dx.doi.org/10.46570/utjms.vol11-2023-680