Network meta-analysis compares palliative approaches for malignant gastric outlet obstruction

A Bayesian network meta-analysis of 15 studies involving 827 patients compared surgical gastrojejunostomy, endoscopic stenting and EUS-guided gastroenterostomy for malignant gastric outlet obstruction. EUS-guided gastroenterostomy ranked highest for clinical success and durability, while endoscopic stenting was associated with more reinterventions; no significant differences were found in adverse events, 30-day mortality or overall survival.

EUS-GE ranked highest for clinical success and durability.
Endoscopic stenting was associated with more reinterventions.
Endoscopic approaches shortened recovery versus surgery.
No significant differences in safety or survival were found.

Malignant gastric outlet obstruction can substantially impair quality of life in people with advanced cancer. This Bayesian network meta-analysis compared surgical gastrojejunostomy (S-GJ), endoscopic stenting (ES) and EUS-guided gastroenterostomy (EUS-GE). The authors searched five databases through April 13, 2026, and included randomized trials and comparative cohort studies in adults. The 15 included studies comprised seven randomized trials and eight cohort studies, with 827 patients overall.

EUS-GE had higher clinical success than S-GJ (risk ratio [RR] 1.38; 95% credible interval [CrI] 1.15–1.88); ES was also superior to S-GJ (RR 1.18; 95% CrI 1.01–1.49). Reintervention was more frequent after ES than after S-GJ (RR 3.61; 95% CrI 1.43–14.51) or EUS-GE (RR 7.56; 95% CrI 2.02–38.14). Both endoscopic approaches were associated with faster return to oral intake and shorter hospital stays than S-GJ. The analysis detected no statistically significant differences in adverse events, 30-day mortality or overall survival.

The findings favor EUS-GE for efficacy and durability, but the authors call for additional direct randomized comparisons. The pooled evidence includes observational cohorts as well as trials, and EUS-GE’s use depends on appropriate expertise. The results do not establish a single optimal palliative approach for every patient.

In practice

For adults with malignant gastric outlet obstruction who need palliation, this analysis suggests EUS-guided gastroenterostomy may offer greater clinical success and durability than surgical gastrojejunostomy or endoscopic stenting, with fewer reinterventions than stenting. Both endoscopic approaches were associated with faster oral intake and shorter hospital stays than surgery. These findings may inform multidisciplinary consideration of procedural options, but they do not establish a universally preferred approach: the evidence combines randomized trials and comparative cohorts, direct randomized comparisons remain needed, and EUS-GE requires appropriate expertise.

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Source

Surgical Endoscopy: Bayesian network meta-analysis comparing efficacy of surgical gastrojejunostomy, endoscopic stenting, and EUS-guided gastroenterostomy for malignant gastric outlet obstruction ↗

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