Palliative surgical bypass is superior to palliative endoscopic stenting in patients with malignant gastric outlet obstruction: systematic review and meta-analysis.
BACKGROUND
Gastrojejunostomy (GJ) and self-expanding metal stents (SEMS) are the two most common palliative treatment options for patients with malignant gastric outlet obstruction (GOO). Randomised trials and retrospective studies have shown discrepant results, so that there is still a controversy regarding the optimal treatment of GOO.


METHODS
Medline, Web of Science and Cochrane Library were systematically searched for studies comparing GJ to SEMS in patients with malignant GOO. Primary outcomes were survival and postoperative mortality. Secondary outcomes were frequency of re-interventions, major complications, time to oral intake and length of hospital stay.


RESULTS
Twenty-seven studies, with a total of 2.354 patients, 1.306 (55.5%) patients in the SEMS and 1.048 (44.5%) patients in the GJ group, were considered suitable for inclusion. GJ was associated with significantly longer survival than SEMS (mean difference 43 days, CI 12.00, 73.70, p = 0.006). Postoperative mortality (OR 0.55, CI 0.27, 1.16, p = 0.12) and major complications (OR 0.73, CI 0.5, 1.06, p = 0.10) were similar in both groups. The frequency of re-interventions, however, was almost three times higher in the SEMS group (OR 2.95, CI: 1.70, 5.14, p < 0.001), whereas the mean time to oral intake and length of hospital stay were shorter in the SEMS group (mean differences - 5 days, CI - 6.75, - 3.05 days, p < 0.001 and - 10 days, CI - 11.6, - 7.9 days, p < 0.001, respectively).


CONCLUSIONS
Patients with malignant GOO and acceptable performance status should be primarily considered for a palliative GJ rather than SEMS.
['Mintziras|Ioannis|I|', 'Miligkos|Michael|M|', 'Wächter|Sabine|S|', 'Manoharan|Jerena|J|', 'Bartsch|Detlef Klaus|DK|']
D004067:Digestive System Neoplasms D004435:Eating D016099:Endoscopy, Gastrointestinal D015390:Gastric Bypass D017219:Gastric Outlet Obstruction D006801:Humans D007902:Length of Stay D010166:Palliative Care D015607:Stents
Surgical bypass Endoscopic stenting Meta-analysis Malignant GOO