Endoscopic Ultrasound–Guided Gastroenterostomy Versus Surgical Gastrojejunostomy for Malignant Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis

Published Date: 01st June 2026

Publication Authors: Asaad. A

Background
Patients with malignant gastric outlet obstruction (GOO) require intervention to restore gastric emptying. Surgical gastrojejunostomy (SGJ) is effective but associated with slower recovery and higher complication rates. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative, but comparative evidence remains limited.

Methods
A systematic review and meta-analysis was conducted including studies comparing EUS-GE and SGJ for malignant GOO. Primary outcomes were technical success, clinical success, and adverse events. Secondary outcomes included procedure duration, time to oral intake, diet tolerance, hospital stay, surgical reintervention, and overall mortality. Pooled analyses were performed using random-effects models, with heterogeneity assessed using I².

Results
Twelve studies including 22,118 patients (4,954 EUS-GE; 17,164 SGJ) were included. EUS-GE had lower technical success (OR 0.25; p = 0.0002) but higher clinical success (OR 1.51; p = 0.04). EUS-GE was associated with shorter procedure time (–93.8 min; p < 0.0001), earlier oral intake (–2.5 days; p = 0.002), and shorter hospital stay (–4.91 days; p < 0.0001). It required fewer reinterventions (OR 0.39; p = 0.02), had fewer adverse events (OR 0.39; p < 0.0001), and showed lower mortality (OR 0.59; p = 0.05). Diet tolerance was similar between groups.

Conclusion
Although EUS-GE had lower technical success, likely due to procedural complexity and anatomical challenges, it provides higher clinical success, faster recovery, fewer complications, and reduced need for reintervention compared with SGJ, supporting its role as a safe and effective minimally invasive alternative for malignant GOO.

Abosheisha, M; Asaad, A et al. (2026). Endoscopic Ultrasound–Guided Gastroenterostomy Versus Surgical Gastrojejunostomy for Malignant Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis. Journal of Gastrointestinal Surgery. Pub online 01 Jun, p.Article 102465. [Online]. Available at: https://doi.org/10.1016/j.gassur.2026.102465 [Accessed 11 June 2026]