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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(06): E874-E897
DOI: 10.1055/a-1794-0635
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
1   Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
,
Shivanand Bomman
1   Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
,
Petros Benias
2   Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, United States
,
Richard A. Kozarek
1   Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
,
Joyce A. Peetermans
3   Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
,
Edmund McMullen
3   Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
,
Ornela Gjata
3   Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
,
Shayan S. Irani
1   Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
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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.

Supplementary material



Publikationsverlauf

Eingereicht: 14. Oktober 2021

Angenommen nach Revision: 13. Januar 2022

Artikel online veröffentlicht:
10. Juni 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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