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Review
. 2022 Jun 10;10(6):E874-E897.
doi: 10.1055/a-1794-0635. eCollection 2022 Jun.

Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis

Rajesh Krishnamoorthi  1 , Shivanand Bomman  1 , Petros Benias  2 , Richard A Kozarek  1 , Joyce A Peetermans  3 , Edmund McMullen  3 , Ornela Gjata  3 , Shayan S Irani  1
Affiliations
Review

Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis

Rajesh Krishnamoorthi et al. Endosc Int Open. .

Abstract

Background and study aims Malignant disease accounts for up to 80 % of gastric outlet obstruction (GOO) cases, which may be treated with duodenal self-expanding metal stents (SEMS), surgical gastrojejunostomy (GJ), and more recently endoscopic-ultrasound-guided gastroenterostomy (EUS-GE). These three treatments have not been compared head-to-head in a randomized trial. Methods We searched the Embase and MEDLINE databases for studies published January 2015-February 2021 assessing treatment of malignant GOO using duodenal SEMS, endoscopic (EUS-GE) or surgical (laparoscopic or open) GJ. Efficacy outcomes assessed included technical and clinical success rates, GOO recurrence and reintervention. Safety outcomes included procedure-related bleeding or perforation, and stent-related events for the duodenal SEMS and EUS-GE arms. Results EUS-GE had a lower rate of technical success (95.3%) than duodenal SEMS (99.4 %) or surgical GJ (99.9%) ( P = 0.0048). For duodenal SEMS vs. EUS-GE vs. surgical GJ, rates of clinical success (88.9 % vs. 89.0 % vs. 92.3 % respectively, P = 0.49) were similar. EUS-GE had a lower rate of GOO recurrence based on limited data ( P = 0.0036), while duodenal SEMS had a higher rate of reintervention ( P = 0.041). Overall procedural complications were similar (duodenal SEMS 18.7 % vs. EUS-GE 21.9 % vs. surgical GJ 23.8 %, P = 0.32), but estimated bleeding rate was lowest ( P = 0.0048) and stent occlusion rate was highest ( P = 0.0002) for duodenal SEMS. Conclusions Duodenal SEMS, EUS-GE, and surgical GJ showed similar clinical efficacy for the treatment of malignant GOO. Duodenal SEMS had a lower procedure-related bleeding rate but higher rate of reintervention.

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Conflict of interest statement

Competing interests Dr. Benias is a consultant for Boston Scientific and Fujifilm. Dr. Kozarek receives research support from Boston Scientific and the National Institutes of Health. Dr. Peetermans, Mr. McMullen and Ms. Gjata are full-time employees of Boston Scientific Corporation. Dr. Irani is a consultant for Boston Scientific and Gore.

Figures

Fig. 1
Fig. 1
Flow diagram of literature search and study selection.
Fig. 2a
Fig. 2a
Analysis of efficacy outcomes. Outcomes for clinical success.
Fig. 2a
Fig. 2a
Analysis of efficacy outcomes. Outcomes for clinical success.
Fig. 2b
Fig. 2b
Analysis of efficacy outcomes. Outcomes for preprocedural GOOSS score.
Fig. 2c
Fig. 2c
Analysis of efficacy outcomes. Outcomes for postprocedural GOOSS score.
Fig. 2d
Fig. 2d
Analysis of efficacy outcomes. Outcomes for recurrence of GOO.
Fig. 2e
Fig. 2e
Analysis of efficacy outcomes. Outcomes for reintervention.
Fig. 3a
Fig. 3a
Analysis of safety outcomes. Outcomes for any procedure-related adverse event.
Fig. 3a
Fig. 3a
Analysis of safety outcomes. Outcomes for any procedure-related adverse event.
Fig. 3b
Fig. 3b
Analysis of safety outcomes. Outcomes for bleeding.
Fig. 3c
Fig. 3c
Analysis of safety outcomes. Outcomes for perforation.
Fig. 3d
Fig. 3d
Analysis of safety outcomes. Outcomes for stent migration.
Fig. 3e
Fig. 3e
Analysis of safety outcomes. Outcomes for e tissue ingrowth.
Fig. 3f
Fig. 3f
Analysis of safety outcomes. Outcomes for stent occlusion.
Fig. 3g
Fig. 3g
Analysis of safety outcomes. Outcomes for stent patency.
Fig. 3h
Fig. 3h
Analysis of safety outcomes. Outcomes for tissue overgrowth.
Fig. 3i
Fig. 3i
Analysis of safety outcomes. Outcomes for deaths reported in AE section.
See this image and copyright information in PMC

References

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