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https://observatorio.fm.usp.br/handle/OPI/42479
Title: | EUS-guided gastroenterostomy versus duodenal stent placement and surgical gastrojejunostomy for the palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis |
Authors: | BOGHOSSIAN, Mateus Bond; FUNARI, Mateus Pereira; MOURA, Diogo Turiani Hourneaux De; MCCARTY, Thomas R.; SAGAE, Vitor Massaro Takamatsu; I, Yen- Chen; MENDIETA, Pastor Joaquin Ortiz; PONTE NETO, Fernando Lopes; BERNARDO, Wanderley Marques; SANTOS, Marcos Eduardo Lera dos; CHAVES, Filipe Tomishige; KHASHAB, Mouen A.; MOURA, Eduardo Guimaraes Hourneaux de |
Citation: | LANGENBECKS ARCHIVES OF SURGERY, v.406, n.6, p.1803-1817, 2021 |
Abstract: | Purpose Malignant gastric outlet obstruction (GOO) is associated with significant morbidity and decreased quality of life, thereby necessitating effective and safe palliative treatment. As such, we sought to compare endoscopic ultrasound-guided gastroenterostomy (EUS-GE) versus duodenal stent (DS) placement and surgical gastrojejunostomy (SGJ) for palliation of malignant GOO. Methods Searches of electronic databases were performed to identify studies comparing EUS-GE versus DS and/or SGJ for palliative treatment of GOO. Outcomes included technical and clinical success, severe adverse events (SAEs), rate of stent obstruction (including tumor ingrowth), length of hospital stay (LOS), reintervention, and 30-day all-cause mortality. Differences in dichotomous and continuous outcomes were reported as risk difference and mean difference, respectively. Results Seven studies (n = 513 patients) were included. When compared to DS placement, EUS-GE was associated with a higher clinical success, fewer SAEs, decreased stent obstruction, lower rate of tumor ingrowth, and decreased need for reintervention. Compared to SGJ, EUS-GE was associated with a lower technical success; however, LOS was significantly decreased. All other outcomes including clinical success, SAEs, reintervention rate, and 30-day mortality were not significantly different between an EUS-guided versus surgical approach. Conclusions EUS-GE was associated with significantly improved outcomes compared to DS placement for palliative treatment of malignant GOO. Despite SGJ possessing a higher technical success compared to EUS-GE, LOS was significantly longer with no difference in clinical success or rate of adverse events. |
Appears in Collections: | Artigos e Materiais de Revistas Científicas - HC/ICHC Artigos e Materiais de Revistas Científicas - LIM/35 Artigos e Materiais de Revistas Científicas - LIM/47 |
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