Comparative efficacy and safety of endoscopic ultrasound-guided gastrojejunostomy versus surgical gastrojejunostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis

Abstract

Background Gastric outlet obstruction (GOO) is a common condition leading to impaired gastric emptying and nutritional decline. Surgical gastrojejunostomy (SGJ) has been the traditionally used bypass approach. Endoscopic ultrasound-guided gastrojejunostomy (EUSGJ) has recently emerged as a promising alternative. This systematic review and meta-analysis aimed to compare the efficacy and safety of EUSGJ vs. SGJ for the management of GOO.

Methods PubMed, Embase, MEDLINE and Cochrane were searched to identify studies that specifically compared outcomes of EUSGJ vs. SGJ in GOO patients. Outcomes assessment focused on procedural metrics and immediate postoperative recovery.

Results Nine retrospective studies incorporating 1086 patients were included. SGJ was superior in terms of technical success (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.05-0.45; P<0.001). EUSGJ was superior in terms of length of hospital stay (mean difference [MD] -4.79, 95%CI -6.52 to -3.06; P<0.001), overall complications (OR 0.24, 95%CI 0.17-0.33, P<0.001), ileus (OR 0.07, 95%CI 0.02-0.17; P<0.001), operative time (MD -96.89, 95%CI -146.16 to -47.61; P<0.001) and infection (OR 0.17, 95%CI 0.08-0.37; P<0.001). No significant differences were demonstrated in terms of clinical success, reintervention, hemorrhage, and perforation.

Conclusions EUSGJ is a safe alternative to SGJ for the palliation of GOO in the arsenal of expert endoscopists. Further research is warranted to establish its place in the complex decision-making process around GOO management in the context of individualized patient care.

Keywords Endoscopic, gastrojejunostomy, gastric, obstruction, meta-analysis

Ann Gastroenterol 2026; 39 (5): 605-613