Bayesian network meta-analysis comparing efficacy of surgical gastrojejunostomy, endoscopic stenting, and EUS-guided gastroenterostomy for malignant gastric outlet obstruction.

IF 3.3 2区医学 Q2 SURGERY

Surgical Endoscopy And Other Interventional Techniques Pub Date : 2026-10-16 DOI:10.1007/s00464-026-13468-z

Zhixin Xie, Zhiyu Yan, Yunlu Feng, Aiming Yang, Wen Shi, Qiang Wang

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引用次数: 0

Abstract

Background and aims: Malignant gastric outlet obstruction (GOO) substantially impairs quality of life in patients with advanced malignancies. Surgical gastrojejunostomy (S-GJ), endoscopic stenting (ES), and EUS-guided gastroenterostomy (EUS-GE) are the principal palliative options. We performed a Bayesian network meta-analysis to compare their efficacy and safety.

Methods: PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched through April 13, 2026. Randomized controlled trials and eligible comparative cohort studies comparing at least two interventions in adults with malignant GOO were included. Bayesian network meta-analysis was performed, and treatments were ranked using the surface under the cumulative ranking curve (SUCRA).

Results: Fifteen studies (7 RCTs and 8 cohort studies; 827 patients) were included. EUS-GE achieved higher clinical success than S-GJ (risk ratio [RR] 1.38, 95% credible interval [CrI] 1.15-1.88; SUCRA 0.98), and ES was also superior to S-GJ (RR 1.18, 95% CrI 1.01-1.49). Reintervention was more frequent with ES than with S-GJ (RR 3.61, 95% CrI 1.43-14.51) or EUS-GE (RR 7.56, 95% CrI 2.02-38.14), whereas EUS-GE ranked highest for durability (SUCRA 0.93). Both endoscopic approaches shortened time to oral intake and hospital stay compared with S-GJ. No statistically significant between-treatment differences were identified for adverse events, 30-day mortality, or overall survival.

Conclusions: EUS-GE was associated with a favorable balance of efficacy, durability, and recovery and may represent a promising minimally invasive alternative in centers with appropriate expertise. ES provides rapid recovery but is associated with more frequent reintervention, whereas S-GJ remains an established option. Additional direct randomized comparisons are needed to define the optimal palliative strategy.

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贝叶斯网络荟萃分析比较外科胃空肠造口术、内镜下支架置入和eus引导下胃造口术治疗恶性胃出口梗阻的疗效。

背景和目的：恶性胃出口梗阻（GOO）严重影响晚期恶性肿瘤患者的生活质量。手术胃空肠造口术（S-GJ）、内镜支架置入（ES）和eus引导下的胃肠造口术（EUS-GE）是主要的姑息治疗选择。我们进行了贝叶斯网络荟萃分析来比较它们的疗效和安全性。方法：检索截至2026年4月13日的PubMed、Embase、Web of Science、Scopus和Cochrane Library。纳入了随机对照试验和符合条件的比较队列研究，比较了至少两种干预措施对成人恶性粘稠症的影响。采用贝叶斯网络进行meta分析，采用累积排序曲线（SUCRA）下的曲面对治疗进行排序。结果：纳入15项研究（7项随机对照试验和8项队列研究，共827例患者）。EUS-GE的临床成功率高于S-GJ（风险比[RR] 1.38, 95%可信区间[CrI] 1.15-1.88; SUCRA 0.98）， ES也优于S-GJ （RR 1.18, 95%可信区间[CrI 1.01-1.49）。ES的再干预频率高于S-GJ （RR 3.61, 95% CrI 1.43-14.51）或EUS-GE (RR 7.56, 95% CrI 2.02-38.14)，而EUS-GE在持久性方面排名最高（SUCRA 0.93）。与S-GJ相比，两种内镜入路均缩短了口服时间和住院时间。治疗间在不良事件、30天死亡率或总生存率方面没有统计学上的显著差异。结论：EUS-GE具有良好的疗效、耐久性和恢复平衡，在具有适当专业知识的中心可能是一种有前途的微创替代方法。ES可以快速恢复，但需要更频繁的再干预，而S-GJ仍然是一种成熟的选择。需要额外的直接随机比较来确定最佳的姑息策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Endoscopy And Other Interventional Techniques 医学-外科

CiteScore

6.10

自引率

12.90%

发文量

890

审稿时长

6 months

期刊介绍： Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research. Topics covered in the journal include: -Surgical aspects of: Interventional endoscopy, Ultrasound, Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology, -Gastroenterologic surgery -Thoracic surgery -Traumatic surgery -Orthopedic surgery -Pediatric surgery