TOPLINE:

Among techniques used for palliation of malignant gastric outlet obstruction, endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) yielded the best clinical success and was associated with the lowest need for repeat procedures and shortest hospital stays. Enteral stenting was effective but warranted more reinterventions.

METHODOLOGY:

• Several endoscopic and surgical procedures are used as palliative options for malignant gastric outlet obstruction, but which approach provides the best balance of effectiveness and safety remains unclear.
• Researchers conducted a systematic review and network meta-analysis to compare the effectiveness and safety of enteral stenting, surgical GJ, stomach-partitioning GJ, and EUS-GJ.
• They searched multiple databases through September 2025 and included English-language randomized controlled trials (RCTs) from multiple countries involving adults with malignant gastric outlet obstruction.
• The primary outcome was clinical success, defined as achieving a gastric outlet obstruction score of ≥ 2 on a 4-point scale. For one RCT, the proportion of patients who could assume a solid diet was used as an alternative to the obstruction score.
• Secondary outcomes included technical success, severe adverse events, need for reintervention, and change in length of hospital stay. Researchers assessed the risk for bias and graded the quality of evidence using relevant tools.

TAKEAWAY:

• The analysis included eight RCTs with 430 patients (mean age range, 61.4-77 years; 41.6%-84% male). The studies had a low risk for bias and moderate quality of evidence.
• All other techniques achieved significantly lower rates of clinical success than EUS-GJ, with a risk ratio of 0.82 for surgical GJ (95% CI, 0.75-0.90; two RCTs), 0.83 for stomach-partitioning GJ (95% CI, 0.75-0.93; network estimate), and 0.91 for enteral stenting (95% CI, 0.85-0.98; one RCT).
• Enteral stenting was associated with a higher risk for reintervention than EUS-GJ (one RCT) and than surgical GJ (three RCTs), although CIs were wide.
• Technical success and rates of severe adverse events did not differ significantly between techniques, but surgical GJ and stomach-partitioning GJ involved about 5-7 days longer hospital stays than EUS‑GJ or enteral stenting.

IN PRACTICE:

“Although EUS-GJ seems to require fewer reinterventions, ES [enteric stent] remains an appropriate option in patients with poor general condition, significant ascites, anatomy unsuitable for EUS-GJ, or limited life expectancy,” the authors of the study wrote.

SOURCE:

The study was led by Mattia Brigida, MD, Università del Salento, Lecce, Italy. It was published online in Gastrointestinal Endoscopy.

LIMITATIONS:

The trials were few and small, which lowered confidence in the findings and required cautious interpretation. Patient groups, procedures, background care, and outcome measures varied across trials, limiting direct comparison. Data on survival and time to restart cancer treatment were missing, and many estimates were imprecise.

DISCLOSURES:

The authors reported receiving no source of funding or having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.