Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany.
Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece.
Surg Endosc. 2019 Oct;33(10):3153-3164. doi: 10.1007/s00464-019-06955-z. Epub 2019 Jul 22.
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.
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.
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).
Patients with malignant GOO and acceptable performance status should be primarily considered for a palliative GJ rather than SEMS.
胃空肠吻合术（GJ）和自膨式金属支架（SEMS）是治疗恶性胃出口梗阻（GOO）患者的两种最常见的姑息性治疗选择。随机试验和回顾性研究得出了不一致的结果，因此对于 GOO 的最佳治疗方法仍存在争议。
系统检索了 Medline、Web of Science 和 Cochrane Library 中比较恶性 GOO 患者 GJ 与 SEMS 的研究。主要结局为生存和术后死亡率。次要结局为再干预频率、主要并发症、开始口服摄入时间和住院时间。
共纳入 27 项研究，总计 2354 例患者，SEMS 组 1306 例（55.5%），GJ 组 1048 例（44.5%）。GJ 组的生存时间明显长于 SEMS 组（平均差异 43 天，CI 12.00，73.70，p=0.006）。两组术后死亡率（OR 0.55，CI 0.27，1.16，p=0.12）和主要并发症（OR 0.73，CI 0.5，1.06，p=0.10）相似。然而，SEMS 组的再干预频率几乎高出三倍（OR 2.95，CI：1.70，5.14，p<0.001），而 SEMS 组开始口服摄入的平均时间和住院时间更短（平均差异-5 天，CI-6.75，-3.05 天，p<0.001 和-10 天，CI-11.6，-7.9 天，p<0.001）。
对于具有可接受的一般情况的恶性 GOO 患者，应首先考虑姑息性 GJ 而非 SEMS。
