Palliative procedures for malignant gastric outlet obstruction: a network meta-analysis

Area of Science:

• Gastroenterology
• Surgical Oncology
• Interventional Endoscopy

Background:

• Optimal palliative treatment for malignant gastric outlet obstruction (GOO) is not definitively established.
• This review focuses on comparing gastrojejunostomy, endoscopic ultrasound-guided gastroenterostomy (EUS-GE), stomach-partitioning gastrojejunostomy (PGJ), and endoscopic stenting for malignant GOO.

Purpose of the Study:

• To systematically review and compare the efficacy and safety of four palliative treatments for malignant GOO.
• To identify the optimal treatment strategy based on clinical success, mortality, reintervention, and complication rates.

Main Methods:

• A systematic search of multiple databases (PubMed, Embase, Cochrane, Scopus, Web of Science) and clinical trial registries was conducted.
• Included randomized controlled trials (RCTs) and cohort studies reporting key clinical outcomes.
• Network meta-analysis using a frequentist approach with inverse variance modeling was performed to rank treatments by P-score.

Main Results:

• The analysis included 3617 patients from 39 studies (4 RCTs, 4 prospective, 32 retrospective).
• Stomach-partitioning gastrojejunostomy (PGJ) demonstrated superior clinical success and lower reintervention rates (P-scores: 0.95, 0.90).
• Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) showed the highest probability for reduced 30-day mortality and complications (P-scores: 0.82, 0.99).
• Cluster ranking confirmed the benefits of both PGJ and EUS-GE for mortality and reintervention.

Conclusions:

• Both PGJ and EUS-GE are recommended as effective palliative treatments for malignant GOO.
• PGJ is a viable alternative, particularly in resource-limited settings or for patients unsuitable for EUS-GE.