Malignant gastric outlet obstruction: Which is the best therapeutic option?

Table 1 Characteristics of the available randomized trials comparing duodenal stenting and surgical gastrojejunostomy for malignant gastric outlet obstruction

Ref.	Randomized patients	Treated patients	Type of stent	Surgical technique	Main outcome measures	Technical success	Clinical success	Adverse events	Hospital stay (d, median)	Reintervention	Follow-up
Fiori et al[58], 2004	Stent group: 9	9	Covered SEMS (Ultraflex, Boston)	Open GJ	Gastric emptying (after 15 d)	9/9 (100%)	9/9 (100%)	2/9 (22.2%)	3.1	7/9 (77.7%)	3 mo
	Surgery group: 9	9				9/9 (100%)	8/9 (88.9%)	2/9 (22.2%)	10	1/9 (11.1%)
Mehta et al[59], 2006	Stent group: 13	12	Wallstent (Boston)1	Laparoscopic GJ	Safety quality of life	10/12 (83.3%)	Significant improvement in Physical Health score after 1 mo in duodenal stent group	0/10 (0%)	5.2	NA	12 mo
	Surgery group: 14	13				13/13 (100%)		10/13 (76.9%)	11.4
Jeurnink et al[57], 2010	Stent group: 21	20	Wallflex (Boston)	Laparoscopic or open GJ	GOOSS improvement	20/21 (95.2%)	17/21 (80.9%)	8/21 (38.1%)	7	2/21 (9.5%)	Median survival: 72 d (GJ) vs 50 d (SEMS)
						17/18 (94.4%)	14/18 (77.7%)	5/21 (23.8%)	15	7/182 (38.8%)
	Surgery group: 18	17

¹In this study, the stents were positioned under fluoroscopic guidance.

²Seven patients experienced 10 adverse events. SEMS: Self-expanding metal stent; GJ: Gastrojejunostomy; GOOSS: Gastric outlet obstruction scoring system.

Table 2 Characteristics of the studies comparing endoscopic ultrasound-guided gastroenterostomy with surgical gastrojejunostomy or duodenal stenting in gastric outlet obstruction

Ref.	Study characteristics	EUS-GE technique	Comparison group	Number of patients	Technical success	Clinical success	Hospital stay (d, median)	Symptom recurrence or re-intervention	Adverse events
Chen et al[80], 2017	Multicenter; Retrospective	EPASS; Balloon-assisted; Direct	Duodenal SEMS	EUS-GE: 30;	26/30 (86.7%);	25/30 (83.3%);	11.3 ± 6.6;	1/30 (4.3%);	5/30 (16.7%);
				SEMS: 52	49/52 (94.2%)	35/52 (67.3%)	9.5 ± 8.3	10/52 (28.6%)	6/52 (11.5%)
Khashab et al[83], 2017	Multicenter; Retrospective	EPASS; Balloon-assisted; Direct	Open GJ	EUS-GE: 30;	26/30 (87%);	26/30 (87%);	11.6 ± 6.6;	1/30 (3%);	5/30 (16.7%);
				Open GJ: 63	63/63 (100%)	57/63 (90%)	12 ± 8.2	9/63 (14%)	16/63 (25%)
Perez-Miranda et al[84], 2017	Multicenter; Retrospective	Assisted; Direct	Laparoscopic GJ (LGJ)	EUS-GE: 251	23/25 (88%);	21/25 (90%);	9.4;	NA;	3/25 (12%);
				LGJ: 29	29/29 (100%)	28/29 (90%)	8.9	NA	12/29 (41%)
Ge et al[85], 2019	Single-center; Retrospective	Assisted; Direct	Duodenal SEMS	EUS-GE: 22; SEMS: 78	22/22 (100%);	21/22 (95.5%);	7.4 ± 9.1;	2/22 (8.3%);	5/22 (20.8%);
					78/78 (100%)	60/78 (76.3%)	7.9 ± 8.2	31/78 (32%)	39/78 (40.2%)

¹Eight patients out of 25 (8/25) underwent endoscopic ultrasonography-guided gastroenterostomy for benign obstruction. EUS-GE: Endoscopic ultrasonography-guided gastroenterostomy; EPASS: Endoscopic ultrasonography-guided double balloon-occluded gastrojejunostomy bypass; SEMS: Self-expanding metal stent; GJ: Gastrojejunostomy.