Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author MINATA, Mauricio Kazuyoshi FMUSP-HC
BERNARDO, Wanderley Marques FMUSP-HC
ROCHA, Rodrigo Silva de Paula FMUSP-HC
MORITA, Flavio Hiroshi Ananias FMUSP-HC
AQUINO, Julio Cesar Martins FMUSP-HC
CHENG, Spencer FMUSP-HC
ZILBERSTEIN, Bruno FMUSP-HC
SAKAI, Paulo FMUSP-HC
MOURA, Eduardo Guimaraes Hourneaux de FMUSP-HC
dc.date.issued 2016
dc.identifier.citation ENDOSCOPY INTERNATIONAL OPEN, v.4, n.11, p.E1158-E1170, 2016
dc.identifier.issn 2364-3722
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/17897
dc.description.abstract Background and study aims: Palliative treatment of gastric outlet obstruction can be done with surgical or endoscopic techniques. This systematic review aims to compare surgery and covered and uncovered stent treatments for gastric outlet obstruction (GOO). Patients and methods: Randomized clinical trials were identified in MEDLINE, Embase, Cochrane, LILACs, BVS, SCOPUS and CINAHL databases. Comparison of covered and uncovered stents included: technical success, clinical success, complications, obstruction, migration, bleeding, perforation, stent fracture and reintervention. The outcomes used to compare surgery and stents were technical success, complications, and reintervention. Patency rate could not be included because of lack of uniformity of the extracted data. Results: Eight studies were selected, 3 comparing surgery and stents and 5 comparing covered and uncovered stents.The meta-analysis of surgical and endoscopic stent treatment showed no difference in the technical success and overall number of complications. Stents had higher reintervention rates than surgery (RD: 0.26, 95% CI [0.05, 0.47], NNH: 4). There is no significant difference in technical success, clinical success, complications, stent fractures, perforation, bleeding and the need for reintervention in the analyses of covered and uncovered stents. There is a higher migration rate in the covered stent therapy compared to uncovered self-expanding metallic stents (SEMS) in the palliation of malignant GOO (RD: 0.09, 95% CI [0.04, 0.14], NNH: 11). Nevertheless, covered stents had lower obstruction rates (RD: -0.21, 95% CI [-0.27,-0.15], NNT: 5). Conclusions: In the palliation of malignant GOO, covered SEMS had higher migration and lower obstruction rates when compared with uncovered stents. Surgery is associated with lower reintervention rates than stents.
dc.language.iso eng
dc.publisher GEORG THIEME VERLAG KG
dc.relation.ispartof Endoscopy International Open
dc.rights openAccess
dc.subject.other expandable metal stents; malignant gastroduodenal obstruction; randomized-trial; laparoscopic gastrojejunostomy; multicenter; metaanalysis; strictures; experience; cancer
dc.title Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review
dc.type article
dc.rights.holder Copyright GEORG THIEME VERLAG KG
dc.description.group LIM/35
dc.identifier.doi 10.1055/s-0042-115935
dc.identifier.pmid 27857965
dc.type.category review
dc.type.version publishedVersion
hcfmusp.author MINATA, Mauricio Kazuyoshi:HC:ICHC
hcfmusp.author BERNARDO, Wanderley Marques:FM:
hcfmusp.author ROCHA, Rodrigo Silva de Paula:HC:ICHC
hcfmusp.author MORITA, Flavio Hiroshi Ananias:HC:ICHC
hcfmusp.author AQUINO, Julio Cesar Martins:HC:ICHC
hcfmusp.author CHENG, Spencer:HC:ICHC
hcfmusp.author ZILBERSTEIN, Bruno:FM:MGT
hcfmusp.author SAKAI, Paulo:FM:MGT
hcfmusp.author MOURA, Eduardo Guimaraes Hourneaux de:HC:ICHC
hcfmusp.origem.id WOS:000388642000007
hcfmusp.publisher.city STUTTGART
hcfmusp.publisher.country GERMANY
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dc.description.index PubMed
dc.identifier.eissn 2196-9736


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