What is the benefit of endoscopic ultrasound-guided gastrojejunal anastomosis for patients with benign gastric outlet obstruction? A systematic review with meta-analysis

Background: Gastric outlet obstruction for benign indications (bGOO) is an uncommon condition, typically treated with surgery when medical therapy or endoscopic treatments fail. At present, endoscopic ultrasound (EUS)-guided gastrojejunostomy (GJ) may prove to be an effective alternative. Aims: We performed a systematic review with meta-analysis evaluating outcomes of EUS-GJ for bGOO. Methods: A comprehensive search was conducted up to February 2025. Pooled estimates were obtained using a random-effects model. Study quality was evaluated using the Newcastle–Ottawa quality scale. Heterogeneity was evaluated with I2 statistic. Technical success, clinical success, recurrence rate, and adverse events (AE) rate were the main outcomes. Results: Fifteen (15) studies, including a total of 376 patients, were identified. Pooled technical success was 95.8 % (CI 95 %, 93.8 %-97.8 %, I2 =0 %), while clinical success was 93.4 % (CI 95 %, 90.4 %-96.5 %, I2= 31.83 %). Pooled recurrence rate was 11.6 % (CI 95 %, 5.5 %-17.7 %, I2=32.36 %). The pooled rate of AE was 11.6 % (CI 95 %, 6.8–16.5 %, I2 = 57.18 %). Subgroup analyses found differences in safety when AE classification was used (17 % use vs. 6 % no use, p = 0.02) and based on quality of studies (low 22 % vs. moderate 10 % vs. high 3 %, p = 0.04). Conclusion: In conclusion, our findings show that EUS-GJ is effective and safe in those patients with bGOO in whom other endoscopic treatments fail, and surgery is not an option or could be performed as bridge-to-surgery. Our results suggest that safety is influenced by the use of AE classification and the quality of studies.