Bayesian network meta-analysis comparing efficacy of surgical gastrojejunostomy, endoscopic stenting, and EUS-guided gastroenterostomy for malignant gastric outlet obstruction

BACKGROUND AND AIMS: Malignant gastric outlet obstruction (GOO) substantially impairs quality of life in patients with advanced malignancies. Surgical gastrojejunostomy (S-GJ), endoscopic stenting (ES), and EUS-guided gastroenterostomy (EUS-GE) are the principal palliative options. We performed a Bayesian network meta-analysis to compare their efficacy and safety. METHODS: PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched through April 13, 2026. Randomized controlled trials and eligible comparative cohort studies comparing at least two interventions in adults with malignant GOO were included. Bayesian network meta-analysis was performed, and treatments were ranked using the surface under the cumulative ranking curve (SUCRA). RESULTS: Fifteen studies (7 RCTs and 8 cohort studies; 827 patients) were included. EUS-GE achieved higher clinical success than S-GJ (risk ratio [RR] 1.38, 95% credible interval [CrI] 1.15-1.88; SUCRA 0.98), and ES was also superior to S-GJ (RR 1.18, 95% CrI 1.01-1.49). Reintervention was more frequent with ES than with S-GJ (RR 3.61, 95% CrI 1.43-14.51) or EUS-GE (RR 7.56, 95% CrI 2.02-38.14), whereas EUS-GE ranked highest for durability (SUCRA 0.93). Both endoscopic approaches shortened time to oral intake and hospital stay compared with S-GJ. No statistically significant between-treatment differences were identified for adverse events, 30-day mortality, or overall survival. CONCLUSIONS: EUS-GE was associated with a favorable balance of efficacy, durability, and recovery and may represent a promising minimally invasive alternative in centers with appropriate expertise. ES provides rapid recovery but is associated with more frequent reintervention, whereas S-GJ remains an established option. Additional direct randomized comparisons are needed to define the optimal palliative strategy.