Bian Shi-Bo, Shen Wei-Song, Xi Hong-Qing, Wei Bo, Chen Lin
Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2016 May 5;129(9):1113-21. doi: 10.4103/0366-6999.180530.
Gastrojejunostomy (GJJ) and endoscopic stenting (ES) are palliative treatments for gastric outlet obstruction (GOO) caused by gastric cancer. We compared the outcomes of GJJ with ES by performing a meta-analysis.
Clinical trials that compared GJJ with ES for the treatment of GOO in gastric cancer were included in the meta-analysis. Procedure time, time to resumption of oral intake, duration of hospital stay, patency duration, and overall survival days were compared using weighted mean differences (WMDs). Technical success, clinical success, procedure-related mortality, complications, the rate of re-obstruction, postoperative chemotherapy, and reintervention were compared using odds ratios (OR s).
Nine studies were included in the analysis. Technical success and clinical success were not significantly different between the ES and GJJ groups. The ES group had a shorter procedure time (WMD = -80.89 min, 95% confidence interval [CI] = -93.99 to -67.78,P < 0.001), faster resumption of oral intake (WMD = -3.45 days, 95% CI = -5.25 to -1.65,P < 0.001), and shorter duration of hospital stay (WMD = -7.67 days, 95% CI = -11.02 to -4.33,P < 0.001). The rate of minor complications was significantly higher in the GJJ group (OR = 0.13, 95% CI = 0.04-0.40,P < 0.001). However, the rates of major complications (OR = 6.91, 95% CI = 3.90-12.25,P < 0.001), re-obstruction (OR= 7.75, 95% CI = 4.06-14.78,P < 0.001), and reintervention (OR= 6.27, 95% CI = 3.36-11.68,P < 0.001) were significantly lower in the GJJ group than that in the ES group. Moreover, GJJ was significantly associated with a longer patency duration (WMD = -167.16 days, 95% CI = -254.01 to -89.31,P < 0.001) and overall survival (WMD = -103.20 days, 95% CI = -161.49 to -44.91, P= 0.001).
Both GJJ and ES are effective procedures for the treatment of GOO caused by gastric cancer. ES is associated with better short-term outcomes. GJJ is preferable to ES in terms of its lower rate of stent-related complications, re-obstruction, and reintervention. GJJ should be considered a treatment option for patients with a long life expectancy and good performance status.
胃空肠吻合术（GJJ）和内镜支架置入术（ES）是治疗胃癌所致胃出口梗阻（GOO）的姑息性治疗方法。我们通过进行一项荟萃分析比较了GJJ和ES的治疗效果。
将比较GJJ与ES治疗胃癌所致GOO的临床试验纳入荟萃分析。使用加权平均差（WMD）比较手术时间、恢复经口进食时间、住院时间、通畅持续时间和总生存天数。使用比值比（OR）比较技术成功率、临床成功率、手术相关死亡率、并发症、再梗阻率、术后化疗和再次干预情况。
分析纳入了9项研究。ES组和GJJ组的技术成功率和临床成功率无显著差异。ES组的手术时间较短（WMD = -80.89分钟，95%置信区间[CI] = -93.99至-67.78，P < 0.001），恢复经口进食更快（WMD = -3.45天，95%CI = -5.25至-1.65，P < 0.001），住院时间更短（WMD = -7.67天，95%CI = -11.02至-4.33，P < 0.001）。GJJ组的轻微并发症发生率显著更高（OR = 0.13，95%CI = 0.04 - 0.40，P < 0.001）。然而，GJJ组的严重并发症发生率（OR = 6.91，95%CI = 3.90 - 12.25，P < 0.001）、再梗阻率（OR = 7.75，95%CI = 4.06 - 14.78，P < 0.001）和再次干预率（OR = 6.27，95%CI = 3.36 - 11.68，P < 0.001）显著低于ES组。此外，GJJ与更长的通畅持续时间（WMD = -167.16天，95%CI = -254.01至-89.31，P < 0.001）和总生存时间（WMD = -103.20天，95%CI = -161.49至-44.91，P = 0.001）显著相关。
GJJ和ES都是治疗胃癌所致GOO的有效方法。ES与更好的短期疗效相关。GJJ在支架相关并发症、再梗阻和再次干预发生率较低方面优于ES。对于预期寿命长且身体状况良好的患者，GJJ应被视为一种治疗选择。
