Conservative management of malignant gastric outlet obstruction syndrome-evidence based evaluation of endoscopic ultrasound-guided gastroentero-anastomosis

Table 1 Causes of malignant gastric outlet obstruction

Site	Pathology
Stomach	Distal gastric cancer
	Gastric lymphoma (e.g., MALT lymphoma)
	Leiomyosarcoma
	Gastrointestinal stromal tumor
	Gastric neuroendocrine neoplasms
Pancreas	Pancreatic adenocarcinoma
	Cystic neoplasm of the pancreas
Duodenum	Duodenal cancer
	Leiomyosarcoma
	Neoplasm of the ampulla
	Gastrointestinal stromal tumor
	Metastasis
Gallbladder and bile duct	Gallbladder and bile duct cancer
Other	Retroperitoneal lymphadenopathy (e.g., metastatic tumor, lymphoma)
	Retroperitoneal sarcoma

MALT: Mucosa-associated lymphoid tissue.

Table 2 Treatment of mechanical malignant gastric outlet obstruction

	Curative	Palliation
Surgery	Surgery (gastrojejunostomy)	Surgical bypass
Endoscopy		Endoscopic stenting
		EUS-GE
		Decompressive gastrostomy with or without feeding tube placement
Chemotherapy and radiotherapy	Chemotherapy (especially for GI lymphoma)	Radiotherapy

GI: Gastrointestinal; EUS-GE: Endoscopic ultrasound-guided gastroenterostomy.

Table 3 Summary of reports in the literature on endoscopic ultrasound-guided gastroenterostomy for malignant gastric outlet obstruction

Ref.	Nation	Study design	Population (n)	Techniques	Technical success (%)	Clinical success (%)	Adverse events(%)	Follow-up (wk)	GOO recurrence (%)
Khashab et al[28], 2015	United States	Retrospective multicenter	10 (3 with malignant GOO)	Direct (n = 1). Balloon-assisted (n = 9)	90	100	0	21	0
Tyberg et al[29], 2016	United States	Retrospective multicenter	26 (17 with malignant GOO)	Direct (n = 3). Balloon-assisted (n = 13). NB catheter assisted (n = 3). Hybrid rendezvous (n = 5)	92	88	11.5	8	0
Itoi et al[30], 2016	Japan	Prospective single center	20	EPASS	90	90	10	14	0
Brewer Gutierrez et al[31], 2017	United States	Retrospective multicenter	7	Direct (n = 5). Balloon-assisted (n = 2)	100	100	0	15	0
Perez-Miranda et al[32], 2017	United States and Europe	Retrospective multicenter	25 (17 with malignant GOO)	Direct (n = 6). Balloon-assisted (n = 9). NB catheter assisted (n = 3). Ultraslim-endoscope assisted (n = 7)	88	84	12	8	0
Khashab et al[33], 2017	United States and Japan	Retrospective multicenter	30	Direct (n = 2). Balloon-assisted (n = 6). EPASS (n = 22)	87	87	16	22	3
Chen et al[34], 2017	United States and Japan	Retrospective multicenter	30	Direct (n = 2). Balloon-assisted (n = 6). EPASS (n = 22)	86.7	83.3	16.7	14	4.3
Chen et al[35], 2018	United States and Europe	Retrospective multicenter	77 (52 with malignant GOO)	Direct (n = 52). Balloon-assisted (n = 22)	94.2	92.3	6.8	17	7
					90.9	90.9			9
Urrehman et al[36], 2018	Singapore	Prospective single center	5	Balloon-assisted EUS-GE	100	80	0	-	-
Ge et al[37], 2019	United States	Prospective single center	22	Direct EUS-GE	100	95.8	20.8	24	4.5
Kerdsirichairat et al[38], 2019	United States	Retrospective multicenter	57 (34 with malignant GOO)	Direct EUS-GE	93	89.5	3.5	28	15.1
Xu et al[39], 2020	China	Retrospective single center	36	Double balloon-assisted EUS-GE	100	94.4	25	13	2.7
Hu et al[40], 2020	China	Prospective single center	9	RPAT-assisted EUS-GE	100	100	-	-	-
Kastelijn et al[41], 2020	Europe	Retrospective multicenter	45	Direct (n = 36). Balloon-assisted (n = 9)	86.7	73.3	26.7	10	5.1
Wannhoff et al[42], 2020	Germany	Retrospective single center	35 (33 with malignant GOO)	Direct (n = 22). Others (n = 12)	80	74.3	14.3	8	10

GOO: Gastric outlet obstruction; NB: Nasobiliary; EUS-GE: Endoscopic ultrasound-guided gastroenterostomy; EPASS: EUS-guided double balloon-occluded gastrojejunostomy bypass; RPAT: Retrievable puncture anchor traction.