Clin Endosc.  2023 May;56(3):298-307. 10.5946/ce.2022.299.

No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis

• Vedantam S
• Shah R
• Bhalla S
• Kumar S
• Amin S

• KMID: 2542455
• DOI: http://doi.org/10.5946/ce.2022.299

Abstract

Background/Aims
We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction.
Methods
Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed.
Results
Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%–95.2%) and 92.1% (95% CI, 68.4%–98.4%), clinical success rates of 88.6% (95% CI, 85.4%–91.1%) and 89.6% (95% CI, 79.0%–95.1%), adverse event rates of 11.4% (95% CI, 8.1%–15.9%) and 14.7% (95% CI, 4.4%–39.1%), and reintervention rates of 10.3% (95% CI, 6.7%–15.4%) and 3.5% (95% CI, 1.6%–7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40–9.18; p=0.008).
Conclusions
No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent.

Keyword

Endoscopic ultrasound; Gastric outlet obstruction; Gastroenterostomy; Gastrojejunostomy; Lumen apposing metal stent

Figure

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  Fig. 1. Literature review flowchart. Describes a methodology for literature search and exclusion criteria for inclusion into meta-analysis. LAMS, lumen-apposing metal stent.

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  Fig. 2. Forest plots demonstrating technical success, clinical success, adverse events, and reintervention events between 15 mm and 20 mm lumen-apposing metal stents. Included tables report on group event rate, 95% confidence intervals (CIs), and p-values.

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