Both Gastrojejunostomy (GJ) and endoscopic stenting (ES) are safe and effective intervention modalities for malignant Gastric outlet obstruction (GOO), according to a recent study published in the American Journal of Surgery.
Gastric outlet obstruction (GOO) is a recognized common complication in patients with upper gastrointestinal cancer. The incidence of pancreatic cancer is 7.1 cases per 100,000 people, and about 15–20% of these patients develop GOO.2 In addition, GOO is also one of the typical clinical symptoms of advanced gastric cancer. GOO is typically accompanied by severe nausea, vomiting, bloating, and malnutrition, significantly impacting patients' survival and quality of life.3 Since most patients suffer from locally advanced or metastatic cancers and have a poor prognosis, the main objectives of palliative treatment are to improve the general condition of patients, re-establish an oral intake quickly, with minimal complications, and without compromising survival.
This study aimed to determine the optimal intervention modality for malignant GOO by comparing clinical outcomes after Gastrojejunostomy and endoscopic stenting. Two authors independently searched Web of Science, PubMed, Embase, and the Cochrane Library for articles before February 2021 to compare the clinical outcomes of GOO patients undergoing GJ or ES.
The Results of the study are as follows:
This meta-analysis included 31 articles with 2444 GOO patients. Although the GJ group outperformed the ES group in technical success (OR,3.79; P = 0.003), clinical success was not significantly different between the two groups (OR,1.25; P = 0.50). The GJ group had a longer hospitalization, lower re-obstruction and lower reintervention. Moreover, GJ had better survival than ES in the gastric cancer group (HR, 0.33; P = 0.009). However, no significant statistical difference was observed in the pancreatic cancer group (HR, 0.55; P = 0.159).
Thus, the researchers concluded that both GJ and ES are safe and effective intervention modalities for malignant GOO. GJ had significantly improved survival in gastric cancer patients with GOO, while no significant difference was observed between the two groups in pancreatic cancer patients with GOO.
Reference:
Comparison of gastrojejunostomy to endoscopic stenting for gastric outlet obstruction: An updated Systematic Review and Meta‐analysis Jiaze Hong et al published in the American Journal of Surgery.
https://doi.org/10.1016/j.amjsurg.2021.10.038