Short-term relief or long-term solution? A comparison between endoscopic stenting and gastrojejunostomy for malignant gastric outlet obstruction

Introduction Malignant gastric outlet obstruction is the consequence of advanced cancer resulting in mechanical obstruction to gastric emptying. Traditionally, surgical bypass (GJ) is performed and is known for its durability but also for its high morbidity. In contrast, endoscopic stenting (ES) is less invasive option but carries a notable risk of stent dysfunction and the need for subsequent reinterventions. These patients usually have limited life expectancy with reduced quality of life. The aim of this study is to review the different treatment options and compare their safety and efficacy. Method We performed a systematic review and meta-analysis comparing GJ to ES for malignant gastric outlet obstruction (mGOO). Comprehensive search of electronic databases between January 2001 and December 2022 was performed to identify relevant studies. The primary outcomes assessed were length of stay, reintervention rate, procedure-related complications and secondary outcome was mortality. Results 32 articles were abstracted in this meta-analysis with a total of 3296 patients. The re-intervention pooled risk ratio was 0.34 (95% CI 0.22, 0.52), indicating the risk of reintervention was lower among patients who underwent GJ. However, the results were comparable between ES and GJ for procedure-related complications and mortality. The length of stay was higher among those who underwent GJ, with a weighted mean difference of 11.2 days (95% CI 4.4, 18.1). Conclusion GJ bypass was associated with lower risk of re-intervention and comparable mortality and procedure-related complications compared to ES in patients with malignant gastric outlet obstruction, despite also being associated with longer length of stay.