Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2015; 21(43): 12468-12481
Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12468
Self-expandable metal stents for malignant gastric outlet obstruction: A pooled analysis of prospective literature
Emo E van Halsema, Erik AJ Rauws, Paul Fockens, Jeanin E van Hooft
Emo E van Halsema, Erik AJ Rauws, Paul Fockens, Jeanin E van Hooft, Department of Gastroenterology and Hepatology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
Author contributions: van Halsema EE, Rauws EAJ, Fockens P and van Hooft JE contributed to conception and design, analysis and interpretation of the data, drafting of the article and final approval of the article; Rauws EAJ, Fockens P and van Hooft JE contributed to critical revision of the article.
Conflict-of-interest statement: Emo E van Halsema and Erik AJ Rauws no conflict of interest; Paul Fockens doing consultancy work for Boston Scientific, Covidien and Olympus Medical Systems; Jeanin van Hooft doing consultancy work for Cook Medical, Boston Scientific, Covidien and Abbott.
Data sharing statement: All data in this systematic review were extracted from the original articles and are presented in the literature Table 1. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Jeanin E van Hooft, MD, PhD, Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, Room C2-116, 1105 AZ Amsterdam, The Netherlands.
Telephone: +31-20-5667918 Fax: +31-20-6917033
Received: April 28, 2015
Peer-review started: May 6, 2015
First decision: July 14, 2015
Revised: July 17, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: November 21, 2015

AIM: To provide an overview of the clinical outcomes of self-expandable metal stent (SEMS) placement for malignant gastric outlet obstruction (MGOO).

METHODS: A systematic literature search was performed in PubMed of the literature published between January 2009 and March 2015. Only prospective studies that reported on the clinical success of stent placement for MGOO were included. The primary endpoint was clinical success, defined according to the definition used in the original article. Data were pooled and analyzed using descriptive statistics. Subgroup analyses were performed for partially covered SEMSs (PCSEMSs) and uncovered SEMSs (UCSEMSs) using Fisher’s exact test.

RESULTS: A total of 19 studies, including 1281 patients, were included in the final analysis. Gastric (42%) and pancreatic (37%) cancer were the main causes of MGOO. UCSEMSs were used in 76% of patients and PCSEMSs in 24%. The overall pooled technical success rate was 97.3% and the clinical success rate was 85.7%. Stent dysfunction occurred in 19.6% of patients, mainly caused by re-obstruction (12.6%) and stent migration (4.3%), and was comparable between PCSEMSs and UCSEMSs (21.2% vs 19.1%, respectively, P = 0.412). Re-obstruction was more common with UCSEMSs (14.9% vs 5.1%, P < 0.001) and stent migration was more frequent after PCSEMS placement (10.9% vs 2.2%, P < 0.001). The overall perforation rate was 1.2%. Bleeding was reported in 4.1% of patients, including major bleeding in 0.8%. The median stent patency ranged from 68 to 307 d in five studies. The median overall survival ranged from 49 to 183 d in 13 studies.

CONCLUSION: The clinical outcomes in this large population showed that enteral stent placement was feasible, effective and safe. Therefore, stent placement is a valid treatment option for the palliation of MGOO.

Keywords: Stents, Gastric outlet obstruction, Stomach neoplasms, Pancreatic neoplasms, Intestinal obstruction, palliative care, Systematic review

Core tip: In this pooled analysis of the prospective literature published since January 2009, we provide an extensive overview of the clinical outcomes of stent placement for malignant gastric outlet obstruction. We analyzed the technical and clinical success, stent dysfunction, stent patency, perforation, bleeding and overall survival in 1281 patients treated with enteral stent placement.