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World J Gastrointest Endosc. Feb 10, 2016; 8(3): 165-172
Published online Feb 10, 2016. doi: 10.4253/wjge.v8.i3.165
Treatment of gastric outlet obstruction that results from unresectable gastric cancer: Current evidence
Yasuhiro Miyazaki, Shuji Takiguchi, Tsuyoshi Takahashi, Yukinori Kurokawa, Tomoki Makino, Makoto Yamasaki, Kiyokazu Nakajima, Masaki Mori, Yuichiro Doki
Yasuhiro Miyazaki, Shuji Takiguchi, Tsuyoshi Takahashi, Yukinori Kurokawa, Tomoki Makino, Makoto Yamasaki, Kiyokazu Nakajima, Masaki Mori, Yuichiro Doki, Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita-shi, Osaka 565-0871, Japan
Author contributions: Miyazaki Y, Takiguchi S, Nakajima K, Mori M and Doki Y designed the research; Miyazaki Y, Takiguchi S and Takahashi T performed the research; Kurokawa Y, Makino T and Yamasaki M contributed analytic tools; Kurokawa Y analyzed the data; Miyazaki Y wrote the paper.
Conflict-of-interest statement: The authors declare there is no conflict of interest for this article.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shuji Takiguchi, MD, Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka 565-0871, Japan. stakiguchi@gesurg.med.osaka-u.ac.jp
Telephone: +81-6-68793251 Fax: +81-6-68793259
Received: May 25, 2015
Peer-review started: May 27, 2015
First decision: August 31, 2015
Revised: October 2, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: February 10, 2016
Abstract

Malignant gastric outlet obstruction (GOO) is a common condition that results from locally advanced malignancies in the upper gastrointestinal tract, such as pancreatic, gastric, and other carcinomas. Two types of procedures for malignant GOO, namely, gastrojejunostomy (GJ) with laparotomy or a laparoscopic approach and endoscopic stenting (ES), are currently available. Although numerous previous reports have clarified the benefits and drawbacks of each procedure, whether GJ or ES should be used in patients with GOO that results from gastric cancer who may have a longer life expectancy than patients with other malignancies has not been determined. In this review, which focuses on gastric cancer-induced GOO, we analyzed the two systematic reviews and a meta-analysis that compared GJ and ES and outlined the current status of GOO treatment. We also provide an updated review that includes laparoscopic GJ. Various data from 13 studies in one review and 6 studies in another review were analyzed. Although the main results of the present review indicated that both GJ and ES were efficacious treatments in patients with GOO that resulted from gastric cancer, current evidence suggests that GJ may be the preferable procedure given its good performance status and improved prognosis in gastric cancer patients.

Keywords: Gastric outlet obstruction, Gastrojejunostomy, Endoscopic stenting, Gastric cancer, Review

Core tip: Both gastrojejunostomy (GJ) and endoscopic stenting (ES) are effective treatments in patients with gastric outlet obstruction that results from gastric cancer. The advantages of GJ include fewer late complications and a long patency, whereas the advantages of ES include better short-term outcomes, including the length of the hospital stay. Although no large-scale randomized clinical trials have compared the safety and efficacy of the two procedures, this present literature review indicates the superiority of GJ compared with ES given its good performance status and improved prognosis in gastric cancer patients as well as the widespread use of the less invasive laparoscopic GJ procedure.