A systematic review of methods to palliate malignant gastric outlet obstruction.
BACKGROUND
The traditional approach to palliating patients with malignant gastric outlet obstruction (GOO) has been open gastrojejunostomy (OGJ). More recently endoscopic stenting (ES) and laparoscopic gastrojejunostomy (LGJ) have been introduced as alternatives, and some studies have suggested improved outcomes with ES. The aim of this review is to compare ES with OGJ and LGJ in terms of clinical outcome.


METHODS
A systematic literature search and review was performed for the period January 1990 to May 2008. Original comparative studies were included where ES was compared with either LGJ or OGJ or both, for the palliation of malignant GOO.


RESULTS
Thirteen studies met the inclusion criteria (10 retrospective cohort studies, two randomised controlled trials and one prospective study). Compared with OGJ, ES resulted in an increased likelihood of tolerating an oral intake [odds ratio (OR) 2.6, p = 0.02], a shorter time to tolerating an oral intake (mean difference 6.9 days, p < 0.001) and a shorter post-procedural hospital stay (mean difference 11.8 days, p < 0.001). There were no significant differences between 30-day mortality, complication rates or survival. There were an inadequate number of cases to quantitatively compare ES with LGJ.


CONCLUSIONS
This review demonstrates improved clinical outcomes with ES over OGJ for patients with malignant GOO. However, there is insufficient data to adequately compare ES with LGJ, which is the current standard for operative management. As these conclusions are based on observational studies only, future large well-designed randomised controlled trials (RCTs) would be required to ensure the estimates of the relative efficacy of these interventions are valid.
Ly
Jasen
J
Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
O'Grady
Gregory
G
Mittal
Anubhav
A
Plank
Lindsay
L
Windsor
John A
JA
D004067:Digestive System Neoplasms / Q000150:complications* / Q000191:economics / Q000401:mortality; D016099:Endoscopy, Gastrointestinal / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D017219:Gastric Outlet Obstruction / Q000191:economics / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay; D010166:Palliative Care / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012189:Retrospective Studies; D015607:Stents / Q000191:economics / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome