BACKGROUND Though gastrojejunostomy (GJ) has been a standard palliative procedure for gastric outlet obstruction (GOO), endoscopic stenting (ES) has shown to provide benefits due to its non-invasive approach. The aim of this review is to perform a comprehensive evaluation of ES versus GJ for the palliation of malignant GOO. METHODS MEDLINE, Embase, and CENTRAL databases were searched and comparative studies of adult GOO patients undergoing ES or GJ were eligible for inclusion. The primary outcomes were survival time and mortality. Secondary outcomes included technical success, clinical success, reinterventions, days until oral food tolerance, postoperative adjuvant palliative chemotherapy, postoperative morbidities, length of stay (LOS), and costs. Pairwise meta-analyses using inverse-variance random effects were performed. RESULTS After identifying 2222 citations, 39 full-text articles fit the inclusion criteria. In total, 3128 ES patients (41.4% female, age: 68.0 years) and 2116 GJ patients (40.4% female, age: 66.8 years) were included. ES patients experienced a shorter survival time (mean difference -24.77 days, 95% Cl - 45.11 to  - 4.43, p = 0.02) and were less likely to undergo adjuvant palliative chemotherapy (risk ratio 0.81, 95% Cl 0.70 to 0.93, p = 0.004). The ES group had a shorter LOS, shorter time to oral intake of liquids and solids, and less surgical site infections (risk ratio 0.30, 95% Cl 0.12 to 0.75, p = 0.01). The patients in the ES group were at greater risk of requiring reintervention (risk ratio 2.60, 95% Cl 1.87 to 3.63, p < 0.001). CONCLUSION ES results in less postoperative morbidity and shorter LOS when compared to GJ, however, this may be at the cost of decreased initiation of adjuvant palliative chemotherapy and overall survival, as well as increased risk of reintervention. Both techniques are likely appropriate in select clinical scenarios.

中文翻译：

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胃空肠吻合术与内镜下支架置入术缓解恶性胃出口梗阻：一项系统评价和荟萃分析。

背景 虽然胃空肠吻合术 (GJ) 已成为胃出口梗阻 (GOO) 的标准姑息手术，但内窥镜支架置入术 (ES) 因其非侵入性方法而显示出优势。本综述的目的是对 ES 与 GJ 治疗恶性 GOO 的疗效进行综合评估。方法 搜索 MEDLINE、Embase 和 CENTRAL 数据库，接受 ES 或 GJ 的成年 GOO 患者的比较研究符合纳入条件。主要结果是生存时间和死亡率。次要结果包括技术成功、临床成功、再干预、口服食物耐受前的天数、术后辅助姑息化疗、术后并发症、住院时间 (LOS) 和费用。进行了使用逆方差随机效应的成对荟萃分析。结果 在识别出 2222 条引文后，有 39 篇全文文章符合纳入标准。总共包括 3128 名 ES 患者（41.4% 女性，年龄：68.0 岁）和 2116 名 GJ 患者（40.4% 女性，年龄：66.8 岁）。ES 患者的生存时间较短（平均差异 -24.77 天，95% Cl - 45.11 至 - 4.43，p = 0.02）并且接受辅助姑息性化疗的可能性较小（风险比 0.81，95% Cl 0.70 至 0.93，p = 0.004）。ES 组的 LOS 更短，口服液体和固体的时间更短，手术部位感染更少（风险比 0.30，95% Cl 0.12 至 0.75，p = 0.01）。ES 组患者需要再次干预的风险更高（风险比 2.60，95% Cl 1.87 至 3.63，p < 0.001）。结论 与 GJ 相比，ES 可减少术后并发症并缩短 LOS，但是，这可能以减少辅助姑息化疗的启动和总生存率以及再次干预的风险增加为代价。这两种技术都可能适用于特定的临床情况。