Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 May 30;5(5):CD012506.
doi: 10.1002/14651858.CD012506.pub2.

Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction

Emma Upchurch  1 , Mark Ragusa, Roberto Cirocchi
Affiliations
Meta-Analysis

Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction

Emma Upchurch et al. Cochrane Database Syst Rev. .

Abstract

Background: Malignant gastric outlet obstruction is the clinical and pathological consequence of cancerous disease causing a mechanical obstruction to gastric emptying. It usually occurs when malignancy is at an advanced stage; therefore, people have a limited life expectancy. It is of paramount importance to restore oral intake to improve quality of life for the person in a manner that has a minimal risk of complications and a short recovery period.

Objectives: To assess the benefits and harms of endoscopic stent placement versus surgical palliation for people with symptomatic malignant gastric outlet obstruction.

Search methods: In May 2018 we searched the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase and Ovid CINAHL. We screened reference lists from included studies and review articles.

Selection criteria: We included randomised controlled trials comparing stent placement with surgical palliation for people with gastric outlet obstruction secondary to malignant disease.

Data collection and analysis: Two review authors independently extracted study data. We calculated the risk ratio (RR) with 95% confidence intervals (CI) for binary outcomes, mean difference (MD) or standardised mean difference (SMD) with 95% CI for continuous outcomes and the hazard ratio (HR) for time-to-event outcomes. We performed meta-analyses where meaningful. We assessed the quality of evidence using GRADE criteria.

Main results: We identified three randomised controlled trials with 84 participants. Forty-one participants underwent surgical palliation and 43 participants underwent duodenal stent placement. There may have been little or no difference in the technical success of the procedure (RR 0.98, 95% CI 0.88 to 1.09; low-quality evidence), or whether the time to resumption of oral intake was quicker for participants who had undergone duodenal stent placement (MD -3.07 days, 95% CI -4.76 to -1.39; low-quality evidence).Due to very low-quality evidence, we were uncertain whether surgical palliation improved all-cause mortality and median survival postintervention.The time to recurrence of obstructive symptoms may have increased slightly following duodenal stenting (RR 5.08, 95% CI 0.96 to 26.74; moderate-quality evidence).Due to very low-quality evidence, we were uncertain whether surgical palliation improved serious and minor adverse events. The heterogeneity for adverse events was moderately high (serious adverse events: Chi² = 1.71; minor adverse events: Chi² = 3.08), reflecting the differences in definitions used and therefore, may have impacted the outcomes. The need for reintervention may have increased following duodenal stenting (RR 4.71, 95% CI 1.36 to 16.30; very low-quality evidence).The length of hospital stay may have been shorter (by approximately 4 to 10 days) following stenting (MD -6.70 days, 95% CI -9.41 to -3.98; moderate-quality evidence).

Authors' conclusions: The use of duodenal stent placement in malignant gastric outlet obstruction has the benefits of a quicker resumption of oral intake and a reduced inpatient hospital stay; however, this is balanced by an increase in the recurrence of symptoms and the need for further intervention.It is impossible to draw further conclusions on these and the other measured outcomes, primarily due to the low number of eligible studies and small number of participants which resulted in low-quality evidence. It was not possible to analyse the impact on quality of life each intervention had for these participants.

PubMed Disclaimer

Conflict of interest statement

This report is independent research funded by the National Institute for Health Research (NIHR Cochrane Programme Grants, 13/89/03 ‐ Evidence‐based diagnosis and management of upper digestive, hepatobiliary and pancreatic disorders). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

EU: none known.

MR: none known.

RC: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 1 Re‐establishment of oral intake (technical success of the intervention).
1.2
1.2. Analysis
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 2 Time to re‐establishment of oral intake (days).
1.3
1.3. Analysis
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 3 All‐cause mortality.
1.4
1.4. Analysis
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 4 Median survival postintervention (days).
1.5
1.5. Analysis
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 5 Time to recurrence of obstructive symptoms.
1.6
1.6. Analysis
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 6 Serious adverse events.
1.7
1.7. Analysis
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 7 Serious adverse events: need for reintervention.
1.8
1.8. Analysis
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 8 Minor adverse events.
1.9
1.9. Analysis
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 9 Length of hospital stay (days).
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012506

References

References to studies included in this review

Fiori 2013 {published data only}
    1. Fiori E, Lamazza A, DeMasi E, DeCesare A, Schillaci A, Sterpetti A. Endoscopic stenting for gastric outlet obstruction in patients with unresectable antro pyloric cancer. Systematic review of the literature and final results of a prospective study. The point of view of a surgical group. American Journal of Surgery 2013;206:210‐7. - PubMed
    1. Fiori E, Lamazza A, Volpino P, Burza A, Paparelli C, Cavallaro G, et al. Palliative management of malignant antro‐pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomised prospective trial. Anticancer Research 2004;24:269‐72. - PubMed
Jeurnick 2010 {published data only}
    1. Jeurnick SM, Steyerberg EW, Hooft JE, Eijck CHJ, Schwartz MP, Vleggaar FP, et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicentre randomized trial. Gastrointestinal Endoscopy 2010;71(3):490‐9. - PubMed
    1. Jeurnink SM, Polinder S, Steyerberg EW, Kuipers EJ, Siersema PD. Cost comparison of gastrojejunostomy versus duodenal stent placement for malignant gastric outlet obstruction. Journal of Gastroenterology 2010;45:537‐43. - PubMed
    1. Jeurnink SM, Steyerberg EW, Vleggaare FP, Eijck CHJ, Hooft JE, Schwartz MP, et al. Predictors of survival in patients with malignant gastric outlet obstruction: a patient‐oriented decision approach for palliative treatment. Digestive and Liver Disease 2011;43:548‐52. - PubMed
Mehta 2006 {published data only}
    1. Mehta S, Hindmarsh A, Cheong E, Cockburn J, Saada J, Tighe R, et al. Prospective randomised trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surgical Endoscopy 2006;20:239‐42. - PubMed

References to studies excluded from this review

Abdellah‐Fernandez 2015 {published data only}
    1. Abdellah‐Fernandez O, Parreno‐Manchado FC, Garcia‐Plaza A, Alvarez‐Delgado A. Partial stomach partitioning gastrojejunostomy in the treatment of the malignant gastric outlet obstruction. Cirugia y Cirujanos 2015;83(5):386‐92. - PubMed
Alonso‐Larraga 2012 {published data only}
    1. Alonso‐Larraga JO, Alvaro J, Sobrino‐Cossio S, Hernández‐Guerrero A, Mora‐Levy G, Figueroa‐Barojas P. Self‐expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum. Revista Espanola de Enfermedades Digestivas 2012;104(4):185‐9. - PubMed
Arigami 2016 {published data only}
    1. Arigami T, Uenosono Y, Ishigami S, Yanagita S, Okubo K, Uchikado Y, et al. C Clinical impact of stomach‐partitioning gastrojejunostomy with braun enteroenterostomy for patients with gastric outlet obstruction caused by unresectable gastric cancer. Anticancer Research 2016;36(10):5431‐6. - PubMed
Bukhari 2016 {published data only}
    1. Bukhari M, Itoi T, Elzein M, Baron TH, Nieto J, Chen Y, et al. International multicenter comparative trial of endoscopic ultrasonography guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Gut 2016;4(5 Suppl 1):A408‐9. - PMC - PubMed
Chandrasegaram 2012 {published data only}
    1. Chandrasegaram MD, Eslick GD, Mansfield CO, Liem H, Richardson M, Ahmed S, et al. Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction. Surgical Endoscopy 2012;26:323‐9. - PubMed
Del Piano 2005 {published data only}
    1. Piano M, Ballare M, Montino F, Todesco A, Orsello M, Magnani C, et al. Endoscopy or surgery for malignant GI outlet obstruction?. Gastrointestinal Endoscopy 2005;61:421‐6. - PubMed
El‐Shabrawi 2013 {published data only}
    1. El‐Shabrawi A, Cerwenka H, Bacher H, Kornprat P, Schweiger J, Mischinger HJ. Treatment of malignant gastric outlet obstruction: endoscopic implantation of self‐expanding metal stents versus gastric bypass surgery. European Surgical Research 2013;38(6):451‐5.
Espinel 2006 {published data only}
    1. Espinel J, Sanz O, Vivas S, Jorquera F, Munoz F, Olcoz JL, et al. Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation. Surgical Endoscopy 2006;20:1083‐7. - PubMed
Fiori 2016 {published data only}
    1. Fiori E, Sterpetti AV, Cesare A, Lamazza A. Factors leading to improved results for endoscopic stenting for metastatic antropyloric adenocarcinoma. A comparison with gastrojejunostomy. Journal of Gastrointestinal Surgery 2016;20:1802‐6. - PubMed
Jang 2017 {published data only}
    1. Jang SH, Lee H, Min BH, Kim SM, Kim HS, Carriere KC, et al. Palliative gastrojejunostomy versus endoscopic stent placement for gastric outlet obstruction in patients with unresectable gastric cancer: a propensity score‐matched analysis. Surgical Endoscopy 2017;31(10):4217‐23. - PubMed
Jeurnick 2007a {published data only}
    1. Jeurnick SM, Steyerberg EW, Hof G, Eijck CHJ, Kuipers EJ, Siersema PD. Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. Journal of Surgical Oncology 2007;96(5):389‐96. - PubMed
Johnsson 2004 {published data only}
    1. Johnsson E, Thune A, Liedman B. Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World Journal of Surgery 2004;28:812‐7. - PubMed
Keranen 2013 {published data only}
    1. Keranen I, Kylanpa A, Udd M, Louhimo J, Lepisto A, Halttunen J, et al. Gastric outlet obstruction in gastric cancer: a comparison of three palliative methods. Journal of Surgical Oncology 2013;108:537‐41. - PubMed
Khashab 2013 {published data only}
    1. Khashab M, Ahmad S, Alawad AS, Shin EJ, Kim K. Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surgical Endoscopy 2013;27:2068‐75. - PubMed
Kimura 2013 {published data only}
    1. Kimura Y, Taniguchi H, Yamamoto M, Fujita J, Fujita S, Kishibuchi M, et al. Efficacy of endoscopic gastroduodenal stenting for gastric outlet obstruction caused by unresectable gastric cancer. Gan to Kagaku Ryoho. Cancer & Chemotherapy 2013;40(12):1687‐9. - PubMed
Kubota 2007 {published data only}
    1. Kubota K, Kuroda J, Origuchi N, Kaminishi M, Isayama I, Kawabe T, et al. Stomach‐partitioning gastrojejunostomy for gastroduodenal outlet obstruction. Archives of Surgery 2007;142(7):607‐11. - PubMed
Kumagai 2016 {published data only}
    1. Kumagai K, Rouvelas I, Ernberg A, Persson S, Analatos A, Mariosa D, et al. A systematic review and meta‐analysis comparing partial stomach partitioning gastrojejunostomy versus conventional gastrojejunostomy for malignant gastroduodenal obstruction. Langenbecks Archives of Surgery 2016;401(6):777‐85. - PubMed
Maetani 2004 {published data only}
    1. Maetani I, Tada T, Ukita T, Inoue H, Sakai Y, Nagao J. Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 2004;36(1):73‐8. - PubMed
Maetani 2005 {published data only}
    1. Maetani I, Akatsuka S, Ikeda M, Tada T, Ukita T, Nakamura Y, et al. Self‐expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy. Journal of Gastroenterology 2005;40:932‐7. - PubMed
Mejia 2006 {published data only}
    1. Mejía A, Ospina J, Muñoz A, Albis R, Oliveros R. Palliation of a malignant gastroduodenal obstruction. Revista Colombiana de Gastroenterologia 2006;21(1):17‐21.
Mittal 2004 {published data only}
    1. Mittal A, Windsor J, Woodfield J, Casey P, Lane M. Matched study of three methods for palliation of malignant pyloroduodenal obstruction. British Journal of Surgery 2004;91:205‐9. - PubMed
No 2013 {published data only}
    1. No JH, Kim SW, Lim CH, Kim JS, Cho YK, Park JM, et al. Long‐term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointestinal Endoscopy 2013;78:55‐62. - PubMed
Park 2015 {published data only}
    1. Park CH, Park JC, Kim EH, Chung H. Impact of carcinomatosis and ascites status on long‐term outcomes of palliative treatment for patients with gastric outlet obstruction caused by unresectable gastric cancer: stent placement versus palliative gastrojejunostomy. Gastrointestinal Endoscopy 2015;81:321‐32. - PubMed
Perez‐Miranda 2016 {published data only}
    1. Perez‐Miranda M, Tyberg A, Poletto D, Toscano E, Gaidhane M, Desai AP, et al. EUS guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. Journal of Clinical Gastroenterology 2017;51(10):896‐99. - PubMed
    1. Perez‐Miranda M, Tyberg A, Sharaiha RZ, Toscano E. EUS guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. Gastrointestinal Endoscopy 2016;83(55):175‐6.
Rudolph 2011 {published data only}
    1. Rudolph HU, Post S, Schlüter M, Seitz U, Soehendra N, Kähler G. Malignant gastroduodenal obstruction: retrospective comparison of endoscopic and surgical palliative therapy. Scandinavian Journal of Gastroenterology 2011;46:583‐90. - PubMed
Schmidt 2009 {published data only}
    1. Schmidt C, Gerdes H, Hawkins W, Zucker E. A prospective observational study examining quality of life in patients with malignant gastric outlet obstruction. American Journal of Surgery 2009;198:92‐9. - PubMed
Shimazaki 2013 {published data only}
    1. Shimazaki A, Katsube T, Usuda A, Miyaki A, Asaka S, Yamaguchi K, et al. Examination of stent treatment and bypass surgery for unresectable advanced gastric cancer. Gan to Kagaku Ryoho. Cancer & Chemotherapy 2013;40(12):1693‐95. - PubMed
Taniguchi 2014 {published data only}
    1. Taniguchi H, Tamura S, Takeno A, Sato Y, Morimoto Y, Kusama H, et al. Efficacy of endoscopic gastroduodenal stenting for unresectable gastric cancer with gastric outlet obstruction. Gan to Kagaku Ryoho. Cancer & Chemotherapy 2014;41(12):2334‐6. - PubMed
Tsauo 2016 {published data only}
    1. Tsauo J, Yoo MW, Song HY, Hwang DW, Park JH, Ryu MH, et al. Partially‐covered stent placement versus surgical gastrojejunostomy for the palliation of malignant gastroduodenal obstruction secondary to pancreatic cancer. Abdominal Radiology 2016;41:2233‐40. - PubMed
Tsuchida 2013 {published data only}
    1. Tsuchida K, Kunisaki C, Shirai J, Watanabe T, Ono H, Oshima T, et al. The clinical outcomes of endoscopic stent placement for patients with malignant gastric outlet obstruction ‐ a comparison with gastrojejunostomy. Gan to Kagaku Ryoho. Cancer & Chemotherapy 2013;40(12):1690‐2. - PubMed
Uemura 2018 {published data only}
    1. Uemura S, Iwashita T, Iwata K, Mukai T, Osada S, Sekino T, et al. Endoscopic duodenal stent versus surgical gastrojejunostomy for gastric outlet obstruction in patients with advanced pancreatic cancer. Pancreatology 2018 May 3 [Epub ahead of print]. [DOI: 10.1016/j.pan.2018.04.015] - DOI - PubMed
Van Hooft 2009 {published data only}
    1. Hooft JE, Uitdehaag MJ, Bruno MJ, Timmer R, Siersema PD, Dijkgraaf MGW, et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointestinal Endoscopy 2009;69:1059‐66. - PubMed
Wong 2002 {published data only}
    1. Wong YT, Brams DM, Munson L, Sanders L, Heiss F, Chase M, et al. Gastric outlet obstruction secondary to pancreatic cancer surgical vs endoscopic palliation. Surgical Endoscopy 2002;16:310‐2. - PubMed
Yim 2001 {published data only}
    1. Yim HB, Jacobson BC, Saltzman JR, Johannes RS, Bounds BC, Lee JH, et al. Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointestinal Endoscopy 2001;53:329‐32. - PubMed
Yoshida 2017 {published data only}
    1. Yoshida Y, Fukutomi A, Tanaka M, Sugiura T, Kawata N, Kawai S, et al. Gastrojejunostomy versus duodenal stent placement for gastric outlet obstruction in patients with unresectable pancreatic cancer. Pancreatology 2017;17(6):983‐9. - PubMed
Yukimoto 2018 {published data only}
    1. Yukimoto T, Morisaki T, Komukai S, Yoshida H, Yamaguchi D, Tsuruoka N, et al. The palliative effect of endoscopic uncovered self‐expandable metallic stent placement versus gastrojejunostomy on malignant gastric outlet obstruction: a pilot study with a retrospective chart review in Saga, Japan. Internal Medicine 2018 Feb 9 [Epub ahead of print]. [DOI: 10.2169/internalmedicine.0171-17] - DOI - PMC - PubMed

Additional references

ASA 2014
    1. American Society of Anesthesiologists. ASA physical status classification system, 2014. www.asahq.org/resources/clinical‐information/asa‐physical‐status‐classif... (accessed 8 December 2016).
Bian 2016
    1. Bian SB, Shen WS, Xi HQ, Wei B, Chen L. Palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer: a meta‐analysis comparison of gastrojejunostomy with endoscopic stenting. Chinese Medical Journal 2016;129(9):1113‐21. - PMC - PubMed
Bijen 2009
    1. Bijen CB, Vermeulen KM, Mourits MJ, Bock GH. Costs and effects of abdominal versus laparoscopic hysterectomy: systemic review of controlled trials. PloS One 2009;4(10):e7340. - PMC - PubMed
Chowdhury 1996
    1. Chowdhury A, Dhali GK, Banerjee PK. Etiology of gastric outlet obstruction. American Journal of Gastroenterology 1996;91(8):1679. - PubMed
Clavien 2009
    1. Clavien PA, Barkun J, Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien‐Dindo classification of surgical complications: five year experience. Annals of Surgery 2009;250(2):187‐96. - PubMed
Dindo 2004
    1. Dindo D, Demarties N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery 2004;240(2):205‐13. - PMC - PubMed
Doberneck 1987
    1. Doberneck RC, Berndt GA. Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Archives of Surgery 1987;122:827‐9. - PubMed
Dormann 2004
    1. Dormann A, Meisner S, Verin N, Wenk LA. Self‐expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004;36:543‐50. - PubMed
Espinel 2001
    1. Espinel J, Vivas S, Munoz F, Olcoz JL. Palliative treatment of malignant obstruction of gastric outlet using an endoscopically placed enteral Wallstent. Digestive Diseases and Sciences 2001;46:2322‐4. - PubMed
GRADEpro GDT [Computer program]
    1. GRADE Working Group, McMaster University. GRADEpro GDT. Version (accessed 8 December 2016). Hamilton (ON): GRADE Working Group, McMaster University, 2015.
Gurusamy 2013
    1. Gurusamy KS, Kumar S, Davidson B. Prophylactic gastrojejunostomy for unresectable periampullary carcinoma. Cochrane Database of Systematic Reviews 2013, Issue 2. [DOI: 10.1002/14651858.CD008533.pub3] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hosono 2007
    1. Hosono S, Ohtani H, Arimoto Y, Kanamiya Y. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta‐analysis. Journal of Gastroenterology 2007;42:283‐90. - PubMed
ICH‐GCP 2015
    1. International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use. Code of Federal Regulation and ICH Guidelines. Media (PA): Barnett, 2015.
Isla 2000
    1. Isla AM, Worthington T, Kakkar AK, Williamson RC. A continuing role for surgical bypass in the palliative treatment of pancreatic carcinoma. Digestive Surgery 2000;17:143‐6. - PubMed
Jeurnick 2007b
    1. Jeurnink S, Eijck C, Steyerberg E, Kuipers E. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterology 2007;7(18):1‐10. - PMC - PubMed
Johnson 1990
    1. Johnson CD, Ellis H. Gastric outlet obstruction now predicts malignancy. British Journal of Surgery 1990;77(9):1023. - PubMed
Johnson 1995
    1. Johnson CD. Gastric outlet obstruction malignant until proved otherwise. American Journal of Gastroenterology 1995;90(10):1740. - PubMed
Keus 2006
    1. Keus F, Jong JA, Gooszen HG, Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD006231] - DOI - PubMed
Kozarek 1992
    1. Kozarek RA, Ball TJ, Patterson DJ. Metallic self‐expanding stent application in the upper gastrointestinal tract: caveats and concerns. Gastrointestinal Endoscopy 1992;38:1‐6. - PubMed
Lee 2015
    1. Lee H, Min BH, Lee J, Shin C, Kim Y, Chung H, et al. Covered metallic stents with an anti‐migration design vs. Uncovered stents for the palliation of malignant gastric outlet obstruction: a multicentre, randomised trial. American Journal of Gastroenterology 2015;110(10):1440‐9. - PMC - PubMed
Lillemoe 1999
    1. Lillemoe KD, Cemeron JL, Hardacre JM, Sohn TA, Sauter PK, Coleman J, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer?. Annuals of Surgery 1999;2230:322‐8. - PMC - PubMed
Lopera 2004
    1. Lopera JE, Brazzini A, Gonzales A, Castaneda‐Zuniga WR. Gastroduodenal stent placement: current status. Radiographics 2004;24:1561‐73. - PubMed
Ly 2010
    1. Ly J, O'Grady G, Mittal A, Plank L, Windsor J. A systematic review of methods to palliate malignant gastric outlet obstruction. Surgical Endoscopy 2010;24:290‐7. - PubMed
Minata 2016
    1. Minata M, Bernardo W, Paula Rocha R, Morita F. Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review. Endoscopy International Open 2016;4:E1158‐70. - PMC - PubMed
Miyasaka 2017
    1. Miyasaka Y, Mori Y, Nakata K, Ohtsuka T, Nakaamura M. Prophylactic biliary and gastrointestinal bypass for unresectable pancreatic head cancer: a retrospective case series. JOP 2017;18(6):470‐4.
Nagaraja 2014
    1. Nagaraja V, Eslick G, Cox M. Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction‐a systematic review and meta‐analysis of randomized and non‐randomized trials. Journal of Gastrointestinal Oncology 2014;5(2):92‐8. - PMC - PubMed
Navarra 2006
    1. Navarra G, Musolino C, Venneri A, Marco ML, Bartolotta M. Palliative antecolic isoperistaltic gastrojejunostomy: a randomized controlled trial comparing open and laparoscopic approaches. Surgical Endoscopy 2006;20(12):1831‐4. - PubMed
Pach 2008
    1. Pach R, Orzel‐Nowak A, Scully T. Ludwik Rydygier ‐ contributor to modern surgery. Gastric Cancer 2008;11(4):187‐91. - PubMed
Pan 2014
    1. Pan Y, Pan J, Guo L, Qiu M, Zhang J. Covered versus uncovered self‐expandable metallic stents for palliation of malignant gastric outlet obstruction: a systematic review and meta‐analysis. BMC Gastroenterology 2014;14(170):1‐8. - PMC - PubMed
Reza 2006
    1. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J. Systematic review of laparoscopic versus open surgery for colorectal cancer. British Journal of Surgery 2006;93(8):921‐8. - PubMed
Robinson 1960
    1. Robinson JO. The history of gastric surgery. Postgraduate Medical Journal 1960;36:706‐13. - PMC - PubMed
Shone 1995
    1. Shone DN, Nikoomanesh P, Smith‐Meek MM, Bender JS. Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. American Journal of Gastroenterology 1995;90(10):1769‐70. - PubMed
Siddiqui 2007
    1. Siddiqui A, Spechler SJ, Huerta S. Surgical bypass versus endoscopic stenting for malignant gastroduodenal obstruction: a decision analysis. Digestive Diseases and Sciences 2007;52(1):276‐81. - PubMed
Talseth 2014
    1. Talseth A, Lydersen S, Skjedlestad F, Hveem K, Edna TH. Trends in cholecystectomy rates in a defined population during and after the period of transition from open to laparoscopic surgery. Scandinavian Journal of Gastroenterology 2014;49(1):92‐8. - PubMed
Tendler 2002
    1. Tendler DA. Malignant gastric outlet obstruction: bridging another divide. American Journal of Gastroenterology 2002;97(1):4. - PubMed
Walsh 2009
    1. Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta‐analysis. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2009;144(1):3‐7. - PubMed
Watanapa 1992
    1. Watanapa P, Williamson RC. Surgical palliation for pancreatic cancer: developments during the past two decades. British Journal of Surgery 1992;79:8‐20. - PubMed
Zheng 2012
    1. Zheng B, Wang X, Ma B, Tian J, Jiang L, Yang K. Endoscopic stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Digestive Endoscopy 2012;24:71‐8. - PubMed

References to other published versions of this review

Upchurch 2017
    1. Upchurch E, Cirocchi R, Ragusa M. Stent placement versus surgical palliation for malignant gastric outlet obstruction. Cochrane Database of Systematic Reviews 2017, Issue 1. [DOI: 10.1002/14651858.CD012506] - DOI - PMC - PubMed