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
Review
. 2023 Apr 30;15(9):2585.
doi: 10.3390/cancers15092585.

A Systematic Review of Endoscopic Treatments for Concomitant Malignant Biliary Obstruction and Malignant Gastric Outlet Obstruction and the Outstanding Role of Endoscopic Ultrasound-Guided Therapies

Giacomo Emanuele Maria Rizzo  1   2 , Lucio Carrozza  1 , Dario Quintini  1 , Dario Ligresti  1 , Mario Traina  1 , Ilaria Tarantino  1   3
Affiliations
Review

A Systematic Review of Endoscopic Treatments for Concomitant Malignant Biliary Obstruction and Malignant Gastric Outlet Obstruction and the Outstanding Role of Endoscopic Ultrasound-Guided Therapies

Giacomo Emanuele Maria Rizzo et al. Cancers (Basel). .

Abstract

Background: The treatments for cancer palliation in patients with concomitant malignant biliary obstruction (MBO) and gastric outlet obstruction (MGOO) are still under investigation due to the lack of evidence available in the medical literature. We performed a systematic search and critical review to investigate efficacy and safety among patients with MBO and MGOO undergoing both endoscopic ultrasound-guided biliary drainage (EUS-BD) and MGOO endoscopic treatment.

Methods: A systematic literature search was performed in PubMed, MEDLINE, EMBASE, and the Cochrane Library. EUS-BD included both transduodenal and transgastric techniques. Treatment of MGOO included duodenal stenting or EUS-GEA (gastroenteroanastomosis). Outcomes of interest were technical success, clinical success, and rate of adverse events (AEs) in patients undergoing double treatment in the same session or within one week.

Results: 11 studies were included in the systematic review for a total number of 337 patients, 150 of whom had concurrent MBO and MGOO treatment, fulfilling the time criteria. MGOO was treated by duodenal stenting (self-expandable metal stents) in 10 studies, and in one study by EUS-GEA. EUS-BD had a mean technical success of 96.4% (CI 95%, 92.18-98.99) and a mean clinical success of 84.96% (CI 95%, 67.99-96.26). The average frequency of AEs for EUS-BD was 28.73% (CI 95%, 9.12-48.33). Clinical success for duodenal stenting was 90% vs. 100% for EUS-GEA.

Conclusions: EUS-BD could become the preferred drainage in the case of double endoscopic treatment of concomitant MBO and MGOO in the near future, with the promising EUS-GEA becoming a valid option for MGOO treatment in these patients.

Keywords: EUS-BD; EUS-GEA; GOO; LAMS; MBO; biliary obstruction; cancer; endoscopic ultrasound; endoscopy; gastric outlet obstruction; gastroenteroanastomosis; gastrojejunostomy; pancreas.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of search and screening process: 11 studies were included in the review.
See this image and copyright information in PMC

References

    1. Davids P.H., Groen A., Rauws E., Tytgat G., Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340:1488–1492. doi: 10.1016/0140-6736(92)92752-2. - DOI - PubMed
    1. Zheng B., Wang X., Ma B., Tian J., Jiang L., Yang K. Endoscopic stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Dig. Endosc. 2012;24:71–78. doi: 10.1111/j.1443-1661.2011.01186.x. - DOI - PubMed
    1. Ge P.S., Young J., Dong W., Thompson C. EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction. Surg. Endosc. 2019;33:3404–3411. doi: 10.1007/s00464-018-06636-3. - DOI - PMC - PubMed
    1. Chan S.M., Dhir V., Chan Y., Cheung C., Chow J., Wong I., Shah R., Yip H., Itoi T., Teoh A. Endoscopic ultrasound-guided balloon-occluded gastrojejunostomy bypass, duodenal stent or laparoscopic gastrojejunostomy for unresectable malignant gastric outlet obstruction. Dig. Endosc. 2022 doi: 10.1111/den.14472. - DOI - PubMed
    1. van Wagensveld B.A., Coene P., van Gulik T., Rauws E., Obertop H., Gouma D. Outcome of palliative biliary and gastric bypass surgery for pancreatic head carcinoma in 126 patients. Br. J. Surg. 1997;84:1402–1406. - PubMed

LinkOut - more resources