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. 2014 Apr;5(2):92-8.
doi: 10.3978/j.issn.2078-6891.2014.016.

Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction-a systematic review and meta-analysis of randomized and non-randomized trials

Vinayak Nagaraja  1 , Guy D Eslick  1 , Michael R Cox  1
Affiliations

Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction-a systematic review and meta-analysis of randomized and non-randomized trials

Vinayak Nagaraja et al. J Gastrointest Oncol. 2014 Apr.

Abstract

Background: Open surgical gastrojejunostomy (GJ) has been the treatment of choice, but it has high morbidity and mortality rates. During the last decade, endoscopic self-expandable metal stents (SEMS) have been used. This meta-analysis aimed to compare surgical GJ and endoscopic stenting in palliation of malignant gastric outlet obstruction (GOO).

Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. The search identified 3 randomized controlled trials (RCTs) and 14 non-RCTs reporting on patients who underwent surgical GJ or endoscopic stenting for malignant gastroduodenal outflow obstruction.

Results: THE RESULTS OF THE THREE RCTS DEMONSTRATED THAT SEMS RESULTED IN COMPARABLE MAJOR [ODDS RATIO (OR): 0.62, 95% confidence intervals (CI): 0.021-18.371] and minor (OR: 0.32, 95% CI: 0.049-2.089) complications in a shorter time to tolerating an oral intake (SEMS: 3.55 days and GJ: 7.15 days) and shorter hospital stay (SEMS: 5.1 days and GJ: 12.13 days, however, statistical insignificant P value =0.11). Among the non RCTs: SEMS resulted in a shorter time to tolerating an oral intake (SEMS: 1.48 days and GJ: 8.07 days, P value <0.01), similar rate of complications (OR: 0.33, 95% CI: 0.1-1.08), lower mortality (OR: 0.5, 95% CI: 0.21-1.20, P value <0.01) and a shorter hospital stay (SEMS: 7.61 days and GJ: 19.04 days, P value <0.0001). There was no significant difference between median survival times among RCTs and non RCTs.

Conclusions: These findings suggest that stent placement is associated with better short-term outcomes and hence, duodenal stenting is a safe means of palliating malignant gastric outflow obstruction. However, a large RCT is needed to systematically compare stent placement with GJ with regard to medical effects, quality of life and costs.

Keywords: Endoscopic stenting; gastrojejunostomy (GJ); malignant gastric outlet obstruction (GOO).

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Figures

Figure 1
Figure 1
Flow of included studies.
See this image and copyright information in PMC

References

    1. Lopera JE, Brazzini A, Gonzales A, et al. Gastroduodenal stent placement: current status. Radiographics 2004;24:1561-73 - PubMed
    1. Warshaw AL, Fernández-del Castillo C. Pancreatic carcinoma. N Engl J Med 1992;326:455-65 - PubMed
    1. Maetani I, Tada T, Ukita T, et al. Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 2004;36:73-8 - PubMed
    1. Mukherjee S, Kocher HM, Hutchins RR, et al. Palliative surgical bypass for pancreatic and peri-ampullary cancers. J Gastrointest Cancer 2007;38:102-7 - PubMed
    1. Lesurtel M, Dehni N, Tiret E, et al. Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal. J Gastrointest Surg 2006;10:286-91 - PubMed