EUS–guided gastroenterostomy versus enteral stent placement for malignant gastric outlet obstruction: A reconstructed individual patient data meta-analysis with meta-regression

Malignant gastric outlet obstruction is a frequent complication of advanced pancreatic and gastric antral malignancies requiring palliative intervention. EUS-guided gastroenterostomy (EUS-GE) has emerged as an alternative to enteral stent placement (ESP), but comparative evidence remains limited. We conducted a pairwise and reconstructed individual patient data meta-analysis of randomized controlled trials and cohort studies comparing EUS-GE with duodenal stent placement in adults with malignant gastric outlet obstruction. Systematic searches of PubMed, Web of Science, Scopus, and the Cochrane Library were performed from inception through November 15, 2025. Stent-related failure was the primary outcome and was analyzed as a time-to-event endpoint using reconstructed individual patient data from published Kaplan–Meier curves. Secondary outcomes included technical success, clinical success, overall survival, length of hospital stay, and adverse events. Random-effects models were applied using hazard ratios and risk ratios (RRs) with 95% confidence intervals (CIs). Ten studies comprising 1359 patients were included. EUS-GE was associated with a significantly lower rate of stent-related failure compared with duodenal stenting (hazard ratio, 0.57; 95% CI, 0.45–0.73; P < 0.001). Technical success was slightly lower with EUS-GE (RR, 0.98; 95% CI, 0.97–1.00; P = 0.028), whereas clinical success was significantly higher than ESP (RR, 1.13; 95% CI, 1.08–1.19; P < 0.001). Overall survival, length of hospital stay, and rates of adverse events were comparable between groups. EUS-GE was associated with lower stent-related failure rates and higher clinical success compared with enteral stenting, with similar survival and safety outcomes. Despite slightly lower technical success rates, EUS-GE remains a durable palliative option in experienced centers, while ESP remains appropriate for short-term palliation.