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Background and study aims Surgical gastroenterostomy (SGE) has been the mainstay treatment for gastric outlet obstruction (GOO). The emergence of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) presents a less invasive alternative for palliation of GOO. We conducted a comprehensive review and meta-analysis to compare the effectiveness and safety of EUS-GE compared to SGE. Methods Multiple electronic databases and conference proceedings up to April 2021 were searched to identify studies that reported on safety and effectiveness of EUS-GE in comparison to SGE. Pooled odds ratios (ORs) of technical success, clinical success, adverse events (AE) and recurrence, and pooled standardized mean difference (SMD) of procedure time and post-procedure length of stay (LOS) were calculated. Study heterogeneity was assessed using I 2 and Cochran Q statistics. Results Seven studies including 625 patients (372 EUS-GE and 253 SGE) were included. EUS-GE had lower pooled odds of technical success compared with SGE (OR 0.19, 95 % confidence interval [CI] 0.06–0.60, I 2 0 %). Among the technically successful cases, EUS-GE was superior in terms of clinical success (OR 4.73, 95 % CI 1.83–12.25, I 2 18 %), lower overall AE (OR 0.20, 95 % CI 0.10–0.37, I 2 39 %), and shorter procedure time (SMD –2.4, 95 % CI –4.1, –0.75, I 2 95 %) and post-procedure LOS (SMD –0.49, 95 % CI –0.94, –0.03, I 2 78%). Rates of severe AE (0.89, 95 % CI 0.11–7.36, I 2 67 %) and recurrence (OR 0.49, 95 % CI 0.18–1.38, I 2 49 %) were comparable. Conclusions Our results suggest EUS-GE is a promising alternative to SGE due to its superior clinical success, overall safety, and efficiency. With further evolution EUS-GE could become the intervention of choice in GOO.

A biological role for the non-immune binding of human IgG by group A streptococci is evidenced by its strong association with a subpopulation of strains giving rise to tissue-specific infection. IgG-binding activity lies within many of the M and M-like surface proteins (encoded by emm genes), and several structurally distinct IgG-binding sites are known to exist. In this report, two adjacent IgG-binding domains, differing in their specificity for human IgG subclasses, are localized within the M-like protein, protein H. The putative coding regions for the two IgG-binding domains were mapped for 82 epidemiologically unrelated strains. Both coding regions are associated with phylogenetically distant emm genes, supporting a role for horizontal transfer and intergenomic recombination in the evolution of emm genes. In most instances, the two coding regions are tightly linked, suggesting that there exist strong selective pressures to maintain a two-domain binding motif. Both coding regions are found among all strains bearing emm gene markers associated with impetigo lesions as the principal tissue reservoir, but are absent from most strains that exhibit markers for a predominant nasopharyngeal reservoir. The data support the hypothesis that the pathogenic potential of an isolate is dictated, at least in part, by its unique array of multifunctional emm gene products.