Palliative therapy for malignant gastric outlet obstruction: how does the endoscopic ultrasound-guided gastroenterostomy compare with surgery and endoscopic stenting? A systematic review and meta-analysis

Autor: Rafael Krieger Martins, Vitor Ottoboni Brunaldi, André Luis Fernandes, José Pinhata Otoch, Everson Luiz de Almeida Artifon
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Therapeutic Advances in Gastrointestinal Endoscopy, Vol 16 (2023)
Druh dokumentu: article
ISSN: 2631-7745
26317745
DOI: 10.1177/26317745221149626
Popis: Introduction: The gold-standard procedure to address malignant gastric outlet obstruction (MGOO) is surgical gastrojejunostomy (SGJJ). Two endoscopic alternatives have also been proposed: the endoscopic stenting (ES) and the endoscopic ultrasound-guided gastroenterostomy (EUS-G). This study aimed to perform a thorough and strict meta-analysis to compare EUS-G with the SGJJ and ES in treating patients with MGOO. Materials and Methods: Studies comparing EUS-G to endoscopic stenting or SGJJ for patients with MGOO were considered eligible. We conducted online searches in primary databases (MEDLINE, EMBASE, Lilacs, and Central Cochrane) from inception through October 2021. The outcomes were technical and clinical success rates, serious adverse events (SAEs), reintervention due to obstruction, length of hospital stay (LOS), and time to oral intake. Results: We found similar technical success rates between ES and EUS-G but clinical success rates favored the latter. The comparison between EUS-G and SGJJ demonstrated better technical success rates in favor of the surgical approach but similar clinical success rates. EUS-G shortens the LOS by 2.8 days compared with ES and 5.8 days compared with SGJJ. Concerning reintervention due to obstruction, we found similar rates for EUS-G and SGJJ but considerably higher rates for ES compared with EUS-G. As to AEs, we demonstrated equivalent rates comparing EUS-G and SGJJ but significantly higher ones compared with ES. Conclusion: Despite being novel and still under refinement, the EUS-G has good safety and efficacy profiles compared with SGJJ and ES.
Databáze: Directory of Open Access Journals
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