. 2022 Nov 15;14(11):e31526. doi: 10.7759/cureus.31526

Table 4. GRADE quality of evidence, DGE vs. BTGE.

BTGE, balloon-assisted techniques gastroenterostomy; DGE, direct gastroenterostomy; CI, confidence interval; RR, risk ratio; LOHS, length of hospital stay; TAEs, adverse events; SAEs, severe adverse event

a. Egger’s regression test and Funnel plot showed possible publication bias; b. High heterogeneity; c. The superior confidence interval is higher than two times the median; d. Procedure duration alone does not evaluate the best intervention; e. The LOHS alone does not help to evaluate the best intervention

Certainty assessment							Summary of findings
Participants (studies) follow-up	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Overall certainty of the evidence	Study event rates (%)		Relative effect (95% CI)	Anticipated absolute effects
Participants (studies) follow-up	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Overall certainty of the evidence	With BTGE	With DGE	Relative effect (95% CI)	Risk with BTGE	Risk difference with DGE
Technical Success
863 (20 observational studies) [12,14,23-40]	Not serious	Not serious	Not serious	Not serious	Publication bias strongly suspected^a	⨁⨁⨁◯Moderate	136/145 (93.8%)	680/718 (94.7%)	RR 0.987 (0.943-1.034)	938 per 1,000	12 fewer per 1,000 (from 55 fewer to 31 more)
Clinical Success
863 (20 observational studies) [12,14,23-40]	Not serious	Not serious	Not serious	Not serious	Publication bias strongly suspected^a	⨁⨁⨁◯Moderate	129/145 (89.0%)	648/718 (90.3%)	RR 0.992 (0.935-1.053)	890 per 1,000	7 fewer per 1,000 (from 6 fewer to 46 more)
TAEs
863 (20 observational studies) [12,14,23-40]	Not serious	Not serious	Not serious	Not serious	Publication bias strongly suspected^a	⨁⨁⨁◯Moderate	31/145 (21.4%)	67/718 (9.3%)	RR 0.435 (0.295-0.640)	214 per 1,000	121 fewer per 1,000 (from 191 fewer to 51 fewer)
SAEs
812 (19 observational studies) [12,14,23-39]	Not serious	Serious^b	not serious	Serious^c	Publication bias strongly suspected^a	⨁◯◯◯Very low	8/94 (8.5%)	24/718 (3.3%)	RR 0.415 (0.190-0.905)	85 per 1,000	48 fewer per 1,000 (from 195 fewer to 9 more)
Procedure Duration
539 (14 observational studies) [12,14,24-31,37-40]	Not serious	Very serious^b	Serious^d	Serious^c	publication bias strongly suspected^a	⨁◯◯◯Very low	145	394	-	The mean procedure duration was 64.74 min	Mean 16.26 minutes lower (5.23 lower to 37.75 higher)
LOHS
513 (10 observational studies) [14,23,25-28,30,37,38,40]	Not serious	Serious^b	Serious^e	Not serious	None	⨁⨁◯◯Low	120	393	-	The mean LOHS was 6.85 days	Mean 2.684 days lower (1,031 lower to 4,337 lower)