Palliative Therapy for Gastric Outlet Obstruction Caused by Unresectable Gastric Cancer: A Meta-analysis Comparison of Gastrojejunostomy with Endoscopic Stenting

• Main Authors: Shi-Bo Bian, Wei-Song Shen, Hong-Qing Xi, Bo Wei, Lin Chen
• Format: Article
• Language: English
• Published: Wolters Kluwer 2016-01-01
• Series: Chinese Medical Journal
• Subjects: Endoscopic Stenting; Gastric Cancer; Gastric Outlet Obstruction; Gastrojejunostomy
• Online Access: http://www.cmj.org/article.asp?issn=0366-6999;year=2016;volume=129;issue=9;spage=1113;epage=1121;aulast=Bian

Background: 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. Methods: 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). Results: 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). Conclusions: 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.