Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis

Hosono, Shunsuke; Oda, Hiroshi; Arimoto, Yuichi; Kanamiya, Yoshitetsu

doi:10.1007/s00535-006-2003-y

Cited by 147 publications

(112 citation statements)

References 31 publications

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“…Surgical palliation of GDO is associated with high mortality (up to 7%) and morbidity rates (10%-16%) even with the recent advances in surgical techniques (5). Metallic stent placement has been increasingly used as a minimally invasive method with lower mortality and morbidity rates than surgical GJ (3,7,8,12,14,15). It has high technical success rates similar to surgical palliation (8).…”

Section: Discussionmentioning

confidence: 99%

“…It has high technical success rates similar to surgical palliation (8). It also results in earlier oral intake and shorter hospital stay than surgical GJ with lower costs (6,7,14,15). Nevertheless, the need for reintervention seems to be more common after stent placement due to recurrent obstructive symptoms because of tumor ingrowth and stent migration (7,8).…”

Section: Discussionmentioning

confidence: 99%

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Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

Bulut¹,

Çiftçi²,

Akhan³

et al. 2017

Diagn Interv Radiol

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M alignant gastroduodenal obstruction (GDO) is a common and debilitating complication of advanced gastric, duodenal, and pancreatobiliary cancers. It can also be seen due to lymphoma and metastatic spread of other malignancies (1, 2). Patients classically present with abdominal pain, nausea, and vomiting with resulting malnutrition and weight loss (1-3). The majority of patients have a median survival of only 3-6 months (4, 5).Curative surgery is often not possible and palliative surgical procedures might have high complication rates with delayed postoperative gastric emptying and prolonged hospitalization (1,(5)(6)(7)(8).Fluoroscopic or endoscopic placement of covered and uncovered metallic stents has been commonly performed in the palliation of malignant GDO as an alternative to gastrojejunostomy (GJ) with high technical and clinical success and low complication rates (5). However, recurrent obstruction due to tumor ingrowth and stent migration is a drawback of uncovered and covered metallic stents.The purpose of this study is to evaluate safety and effectiveness of fluoroscopy-guided gastroduodenal metallic stent placement using different approaches such as transoral, transgastric, and transhepatic in 53 patients with malignant obstruction. Patients who underwent combined biliary and duodenal stenting were also assessed. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the safety and effectiveness of fluoroscopy-guided gastroduodenal metallic stent placement with different approaches in malignant obstruction. METHODSWe retrospectively assessed 53 patients (33 men and 20 women; mean age, 58.7±15 years) who underwent stent placement between February 2004 and April 2014. All patients had unresectable tumors. The most common causes of obstruction were gastric (38%) and pancreatic cancers (36%). Uncovered self-expandable metallic stents (SEMS) were placed under fluoroscopic guidance. In addition to transoral approach in 46 patients (86.7%), transgastric and transhepatic approaches were used in six patients (11.3%) and one patient (1.8%), respectively. Gastric outlet obstruction scoring system (GOOSS) was used to evaluate oral intake before and after stenting. Patients were followed until death or the end of the study. RESULTSTechnical and clinical success rates were 100% and 92%, respectively. The median stent patency was 76 days (range, 4-985 days). Mean preprocedural GOOSS score of 0.1 increased to postprocedural GOOSS score of 2.42 (P < 0.001). Afferent loop decompression was achieved in one symptomatic patient. Neither mortality nor major complications occurred due to stenting. Stent migration occurred in one patient (2%) and stent obstruction occurred in two patients (4%). Combined biliary and duodenal stenting were performed in 21 patients (40%). Post-stenting GOOSS scores were predictive of survival (P = 0.003). CONCLUSIONFluoroscopic metallic stent placement for palliation of malignant gastroduodenal obstruction is safe and effective with high technica...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

Bulut¹,

Çiftçi²,

Akhan³

et al. 2017

Diagn Interv Radiol

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“…There have been mixed reports on the technical and clinical success rates, cost of procedure and complication rates. More commonly, studies found no difference between technical and clinical success rates [49][50][51]53], but in a meta-analysis of 307 procedures by Hosono et al [45], clinical success was higher in the stenting group. A recent 10-year retrospective study of stenting versus GJ by Khashab et al [46 •• ] found statistically higher rates of technical success in the GJ group (96 vs. 99 %).…”

Section: Emerging Technologiesmentioning

confidence: 97%

“…Most studies agree that stenting provides the following advantages over laparoscopic or open gastro-jejunostomy: shorter operative time, shorter hospital stay and decreased time to oral intake [44][45][46][47][48][49][50][51][52]. However, they almost universally report decreased patency of stents with higher rates of recurrent obstruction and need for re-intervention [46 •• , 49, 50, 53].…”

Section: Emerging Technologiesmentioning

confidence: 99%

Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction

Miller

Schwaitzberg

2014

Curr Surg Rep

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Gastric outlet obstruction (GOO) can be due to a variety of causes of both benign and malignant sources. As the etiology of GOO shifts from mostly benign to mostly malignant, treatment options have also evolved. Traditional options have only included surgery, but an increase in technology has seen the emergence of endoscopic alternatives. For benign disease, such as peptic ulcer disease, endoscopic balloon dilation has reduced the number of patients needing to undergo larger and more invasive surgical procedures. It has also proven successful in treating obstruction from stricture following bariatric surgery, but surgical revision or reversal remains the gold standard. Numerous surgical procedures have shown effectiveness when treating GOO, with new procedures constantly emerging. When malignancy is the cause, the procedural focus shifts from curative to palliative with the main focus being resumption of oral intake. Endoscopic stenting provides a viable alternative to gastro-jejunostomy, but due to problems with re-obstruction and stent migration, it should be reserved for patients with shorter life expectancies.

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Placement of self expandable metallic stents is associated with higher clinical success rates, less morbidity, shorter times from the procedure to starting oral intake, lower rates of delayed gastric emptying, and shorter hospital stay than palliative surgery. 13,14 This article reviews the use of this minimally-invasive therapeutic option in the palliative treatment of unresectable malignant GOOs.…”

Section: 25mentioning

confidence: 99%

Malignant Gastric Outlet Obstructions: Treatment with Self-Expandable Metallic Stents

2010

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Unresectable malignant gastric outlet obstruction (GOO) severely affects the quality of life, with complications that include nausea, vomiting, aspiration, pain, and malnutrition. Although palliative surgical procedures have been traditionally performed, they are associated with high morbidity and mortality rates. Placing self-expandable metallic stents is associated with higher clinical success rates, lower morbidity, shorter time from the procedure to starting oral intake, lower incidence of delayed gastric emptying, and a shorter hospital stay than palliative surgery. Fluoroscopic or endoscopic placement of either bare or covered selfexpandable metallic stents is a safe, nonsurgical, palliative treatment option for unresectable malignant GOOs, with a high clinical success rate and a low rate of serious complications. Stent obstruction and migration are the most common complications, but most can be managed by interventional treatments. Although there have been substantial developments in stent design over the past decade, large prospective, randomized studies are required to determine the ideal stent for malignant GOOs. (Gut Liver 2010; 4(Suppl. 1):S32-38)

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Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis

Cited by 147 publications

References 31 publications

Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction

Malignant Gastric Outlet Obstructions: Treatment with Self-Expandable Metallic Stents

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