Novel EGAL procedure safe, effective for benign, malignant strictures

Endoscopic gastrointestinal anastomosis using lumen-apposing metal stents (EGAL), a novel technique used as an alternative method to bypass benign or malignant strictures, is relatively safe and can be performed in selected patients, reports a study.

In this procedure, endoscopists take advantage of two bowel loops that are close to each other and place a stent between the lumen of these loops.

The investigators evaluated the efficacy and safety of EGAL in this systematic review and meta-analysis. They searched electronic databases from inception to July 2019 for full eligible articles that assessed the EGAL procedure to bypass malignant or benign obstruction or to restore bowel integrity after a gastrointestinal altering surgery.

Efficacy was assessed through technical and clinical success and safety through adverse events. The rates of stent maldeployment and reintervention were also evaluated during the study period.

Eight studies were included in the meta-analysis, providing data on 269 patients who underwent 271 EGAL procedures. Of the patients (median age 65 years, interquartile range [IQR] 63–66 years, 46 percent males), 203 and 66 had EGALs due to malignant and benign aetiologies, respectively.

Over a median follow-up of 114 days (IQR 78–121 days), EGAL showed a technical success rate of 94.1 percent (95 percent confidence interval [CI], 91.4–96.9 percent) and a clinical success rate of 91.4 percent (95 percent CI, 88.1–94.7 percent).

The rate of adverse events was 8.5 percent (95 percent CI, 4.7–12.3 percent). In addition, stent maldeployment and reintervention rates were 9.5 percent (95 percent CI, 3.5–15.4 percent) and 6.0 percent (95 percent CI, 2.3–9.8 percent), respectively.

“Comparison between EGAL and other conventional therapies is difficult because of the lack of randomized trials,” the investigators said.