title: Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review.
abstract: Background and study aims:Palliative treatment of gastric outlet obstruction can be done with surgical or endoscopic techniques. This systematic review aims to compare surgery and covered and uncovered stent treatments for gastric outlet obstruction (GOO).Patients and methods:Randomized clinical trials were identified in MEDLINE, Embase, Cochrane, LILACs, BVS, SCOPUS and CINAHL databases. Comparison of covered and uncovered stents included: technical success, clinical success, complications, obstruction, migration, bleeding, perforation, stent fracture and reintervention. The outcomes used to compare surgery and stents were technical success, complications, and reintervention. Patency rate could not be included because of lack of uniformity of the extracted data.Results:Eight studies were selected, 3 comparing surgery and stents and 5 comparing covered and uncovered stents.The meta-analysis of surgical and endoscopic stent treatment showed no difference in the technical success and overall number of complications. Stents had higher reintervention rates than surgery (RD: 0.26, 95 % CI [0.05, 0.47], NNH: 4). There is no significant difference in technical success, clinical success, complications, stent fractures, perforation, bleeding and the need for reintervention in the analyses of covered and uncovered stents. There is a higher migration rate in the covered stent therapy compared to uncovered self-expanding metallic stents (SEMS) in the palliation of malignant GOO (RD: 0.09, 95 % CI [0.04, 0.14], NNH: 11). Nevertheless, covered stents had lower obstruction rates (RD: - 0.21, 95 % CI [-0.27, - 0.15], NNT: 5).Conclusions:In the palliation of malignant GOO, covered SEMS had higher migration and lower obstruction rates when compared with uncovered stents. Surgery is associated with lower reintervention rates than stents.
authors.affiliation: University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil.
authors.forename: Mauricio Kazuyoshi
authors.initials: MK
authors.lastname: Minata
authors.affiliation: University of São Paulo Medical School, Gastroenterology Department, São Paulo, Brazil.
authors.forename: Wanderley Marques
authors.initials: WM
authors.lastname: Bernardo
authors.affiliation: University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil.
authors.forename: Rodrigo Silva de Paula
authors.initials: RS
authors.lastname: Rocha
authors.affiliation: University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil.
authors.forename: Flavio Hiroshi Ananias
authors.initials: FH
authors.lastname: Morita
authors.affiliation: University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil.
authors.forename: Julio Cesar Martins
authors.initials: JC
authors.lastname: Aquino
authors.affiliation: University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil.
authors.forename: Spencer
authors.initials: S
authors.lastname: Cheng
authors.affiliation: University of São Paulo Medical School, Digestive Surgery, Gastroenterology Department, São Paulo, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Zilberstein
authors.affiliation: University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
authors.affiliation: University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil.
authors.forename: Eduardo Guimarães Hourneaux
authors.initials: EG
authors.lastname: de Moura