EUS-GJ shows OR 1.85 for clinical success over surgical gastrojejunostomy in GOO

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European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Dermanis Alexander A, Thompson Dominic, Rao Pawan Kumar Dhruva, Hajibandeh Shahab, Hajibandeh Shahin PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider EUS-GJ as first-line for gastric outlet obstruction due to higher clinical success and lower morbidity versus surgery.

This review synthesized evidence from a meta-analysis comparing endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) to surgical gastrojejunostomy (SGJ) for patients with gastric outlet obstruction. The analysis included a total sample size of 22,337 patients. The primary intervention was EUS-GJ, and the comparator was SGJ. The primary outcome was clinical success. The main results showed that EUS-GJ was associated with significantly higher clinical success compared with SGJ (OR 1.85, p = 0.02). EUS-GJ was also associated with a lower risk of overall morbidity (OR 0.28, p < 0.001) and a lower risk of postoperative Clavien-Dindo grade III or higher complications (OR 0.44, p = 0.006). Key secondary outcomes demonstrated that EUS-GJ significantly shortened length of hospital stay (MD -4.38, p < 0.0001), time to oral intake (MD -2.57, p < 0.0001), time to solid intake (MD -4.28, p = 0.027), and time to initiation of chemotherapy (MD -17.9, p < 0.0001) compared with SGJ. Technical success was higher for SGJ (OR 0.34, p = 0.005). No significant differences were found for 30-day mortality (OR 1.03, p = 0.91), overall mortality (OR 0.98, p = 0.89), or reintervention (OR 0.77, p = 0.67). Safety findings indicated that overall adverse events were a key metric, with postoperative Clavien-Dindo grade III or higher complications representing serious adverse events. The review did not report specific adverse event rates or discontinuation data. These results compare to prior landmark studies in this therapeutic area by providing a quantitative synthesis of comparative outcomes. Key methodological limitations include the need for future research, as noted in the limitations section. The review did not report details on study settings, follow-up periods, or funding sources. Clinical implications suggest that EUS-GJ should be considered as a first-choice intervention for isolated gastric outlet obstruction due to favorable clinical success and significantly lower perioperative morbidities compared with SGJ. Surgical approach is indicated if EUS-GJ fails or in the presence of a simultaneous anatomical disturbance requiring surgical correction. Unanswered questions remain regarding long-term outcomes, patient selection criteria, and cost-effectiveness.

Study Details

Study typeMeta analysis

Sample sizen = 22,337

EvidenceLevel 1

PublishedJun 2026

PMID42034575

View Original Abstract ↓

AIMS: To evaluate comparative outcomes of endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) and surgical gastrojejunostomy (SGJ) for management of gastric outlet obstruction (GOO). METHODS: A systematic search of electronic data sources was conducted and all comparative studies investigating outcomes of EUS-GJ and SGJ were identified and their risk of bias were evaluated. Technical success, clinical success, length of hospital stay, overall adverse events, postoperative Clavien-Dindo (C-D) ≥ III complications, time to soft intake, time to oral intake, time to initiation of chemotherapy, overall mortality, 30-day mortality, readmissions, reintervention, among other outcomes were evaluated. RESULTS: Fourteen studies reporting a total of 22,337 patients were included (5172 EUS-GJ versus 17,165 SGJ). EUS-GJ was associated with significantly higher clinical success (OR 1.85, p = 0.02) and lower risk of overall morbidity (OR 0.28, p < 0.001), postoperative C-D > III complications (OR 0.44, p = 0.006) compared with SGJ. Moreover, it significantly shortened length of stay (MD -4.38, p < 0.0001), time to oral intake (MD -2.57, p < 0.0001), time to solid intake (MD -4.28, p = 0.027) or time to chemotherapy (MD -17.9, p < 0.0001). However, SGJ had significantly higher technical success (OR 0.34, p = 0.005). There was no significant difference in 30-day mortality (OR 1.03, p = 0.91), overall mortality (OR 0.98, p = 0.89) or reintervention (OR 0.77 p = 0.67) between groups. CONCLUSIONS: Where available, EUS-GJ should be considered as the first-choice intervention for isolated GOO considering favourable clinical success and significantly lower perioperative morbidities when compared with SGJ. Surgical approach is indicated if EUS-GJ fails or in the presence of a simultaneous anatomical disturbance that requires surgical correction. Future research is needed.