Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, Room G814, 50 Charlton Ave. East, Hamilton, ON, Canada.
Surg Endosc. 2023 Jun;37(6):4834-4868. doi: 10.1007/s00464-022-09572-5. Epub 2022 Sep 22.
Though gastrojejunostomy (GJ) has been a standard palliative procedure for gastric outlet obstruction (GOO), endoscopic stenting (ES) has shown to provide benefits due to its non-invasive approach. The aim of this review is to perform a comprehensive evaluation of ES versus GJ for the palliation of malignant GOO.
MEDLINE, Embase, and CENTRAL databases were searched and comparative studies of adult GOO patients undergoing ES or GJ were eligible for inclusion. The primary outcomes were survival time and mortality. Secondary outcomes included technical success, clinical success, reinterventions, days until oral food tolerance, postoperative adjuvant palliative chemotherapy, postoperative morbidities, length of stay (LOS), and costs. Pairwise meta-analyses using inverse-variance random effects were performed.
After identifying 2222 citations, 39 full-text articles fit the inclusion criteria. In total, 3128 ES patients (41.4% female, age: 68.0 years) and 2116 GJ patients (40.4% female, age: 66.8 years) were included. ES patients experienced a shorter survival time (mean difference -24.77 days, 95% Cl - 45.11 to - 4.43, p = 0.02) and were less likely to undergo adjuvant palliative chemotherapy (risk ratio 0.81, 95% Cl 0.70 to 0.93, p = 0.004). The ES group had a shorter LOS, shorter time to oral intake of liquids and solids, and less surgical site infections (risk ratio 0.30, 95% Cl 0.12 to 0.75, p = 0.01). The patients in the ES group were at greater risk of requiring reintervention (risk ratio 2.60, 95% Cl 1.87 to 3.63, p < 0.001).
ES results in less postoperative morbidity and shorter LOS when compared to GJ, however, this may be at the cost of decreased initiation of adjuvant palliative chemotherapy and overall survival, as well as increased risk of reintervention. Both techniques are likely appropriate in select clinical scenarios.
尽管胃肠吻合术（GJ）已成为治疗胃出口梗阻（GOO）的标准姑息性手术，但内镜支架置入术（ES）因其非侵入性方法而显示出益处。本综述的目的是全面评估 ES 与 GJ 治疗恶性 GOO 的疗效。
检索 MEDLINE、Embase 和 CENTRAL 数据库，并纳入接受 ES 或 GJ 的成年 GOO 患者的对照研究。主要结局是生存时间和死亡率。次要结局包括技术成功率、临床成功率、再干预、口服耐受时间、术后辅助姑息性化疗、术后并发症、住院时间（LOS）和成本。采用逆方差随机效应进行两两荟萃分析。
在确定了 2222 条引文后，有 39 篇全文文章符合纳入标准。共有 3128 名 ES 患者（41.4%为女性，年龄：68.0 岁）和 2116 名 GJ 患者（40.4%为女性，年龄：66.8 岁）纳入研究。ES 患者的生存时间更短（平均差异 -24.77 天，95%置信区间-45.11 至-4.43，p=0.02），且更不可能接受辅助姑息性化疗（风险比 0.81，95%置信区间 0.70 至 0.93，p=0.004）。ES 组的 LOS 更短，液体和固体口服摄入时间更短，且手术部位感染更少（风险比 0.30，95%置信区间 0.12 至 0.75，p=0.01）。ES 组患者再干预的风险更高（风险比 2.60，95%置信区间 1.87 至 3.63，p<0.001）。
与 GJ 相比，ES 可降低术后发病率和 LOS，但可能会降低辅助姑息性化疗和总生存率的启动率，并增加再干预的风险。两种技术在特定临床情况下可能都适用。
