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EUS-GJ shows OR 1.85 for clinical success over surgical gastrojejunostomy in GOONew review shows endoscopic procedure works better than surgery for blocked stomach openings in many patients

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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.

Doctors often face a tough choice when treating a blocked opening between the stomach and small intestine. This condition is called gastric outlet obstruction. A new review looked at data from over twenty-two thousand patients to compare two main treatment options. One option is a surgical procedure called surgical gastrojejunostomy. The other is a newer endoscopic method known as EUS-GJ. This review helps doctors decide which path is best for their patients.

The endoscopic method showed much higher success rates in getting the blockage cleared. Patients who had the endoscopic treatment were far more likely to have their stomach working normally again. In contrast, the surgical approach had a slightly lower chance of clearing the blockage completely. This difference is important because it means more patients get relief with the endoscopic tool.

Recovery was also much faster with the endoscopic option. Patients stayed in the hospital for about four days less time. They could start drinking liquids and eating soft foods much sooner. This speedier recovery helps patients feel better and return to their normal daily lives quickly. Getting back to eating regular food is a major goal for anyone with this stomach problem.

Safety was another big advantage for the endoscopic procedure. Patients had a much lower risk of serious complications or general health issues after the treatment. The surgical method carried a higher risk of these problems. However, both methods had similar rates of death within thirty days or over the long term. Neither method caused more people to need extra surgeries later on.

Doctors now suggest trying the endoscopic procedure first for most patients. It works very well and keeps patients safer during recovery. Surgery is still needed if the endoscopic method does not work. It is also needed if there are other structural problems that require fixing. Choosing the right treatment depends on each patient's specific situation.

This review gives strong evidence that the endoscopic method is a better first choice. It offers higher success and fewer risks without increasing the danger of death. Patients and families can feel more confident knowing there is a safer option available. This change in practice will help many people recover from their stomach blockage more easily.

What this means for you:
Endoscopic treatment works better and is safer than surgery for clearing blocked stomach openings in most patients.

Study Details

Study typeMeta analysis
Sample sizen = 22,337
EvidenceLevel 1
PublishedJun 2026
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.
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