The aim in palliating patients with malignant GOO is to re-establish an oral intake by restoring gastrointestinal continuity. This ultimately P450 inhibitor mouse improves patients’ quality of life in

the advanced stages of cancer. Traditionally, surgical gastrojejunostomy (GJ) has been the standard treatment approach for these patients. Although GJ relieves symptoms in almost all patients, the procedure is associated with morbidity of 10-16% and mortality of up to 7% (3-5). Also, post-operatively, most patients suffer delayed gastric emptying that is often associated with longer hospital stay (6). Although laparoscopic Inhibitors,research,lifescience,medical GJ has been introduced as a less invasive alternative to open GJ, the technique still carries substantial risk and is not widely available (7-10). Endoscopic placement Inhibitors,research,lifescience,medical of self-expandable metal stents (SEMSs) has emerged as an alternative means for palliation of GOO. Multiple uncontrolled case-series studies have demonstrated SEMSs to be safe

and effective with technical success of 90-100% and clinical success of 67-100% (11-17). Randomized trials have shown mixed results, with two trials Inhibitors,research,lifescience,medical favouring endoscopic SEMS (18,19) and one favouring surgical GJ (20). Therefore, it is currently unknown whether patients with GOO are best palliated with endoscopic SEMS placement or GJ. Also, SEMS are expensive and it is unclear whether their use is less costly when compared with surgical GJ. Although direct cost studies have shown that SEMS placement is less Inhibitors,research,lifescience,medical costly than surgery, the general applicability of the data is debatable given the small number of patients enrolled in each of these single-institution trials (7,21,22). Hence we performed this meta-analysis to compare outcomes of endoscopic stenting (ES) with GJ. The primary goal of this study is to the

compare the overall complication rate and effectiveness (ability to tolerate oral intake) of SEMS and GJ in patients with GOO. The secondary objective is to identify predictors of clinical outcomes [reintervention Inhibitors,research,lifescience,medical rate, length of hospital stay (LOHS), hospitalization charges, and complications]. Methods Study protocol We followed the Preferred Unoprostone Reporting Items for Systematic reviews and Meta-Analyses PRISMA guidelines where possible in performing our systematic review (23). We performed a systematic search through MEDLINE (from 1950), PubMed (from 1946), EMBASE (from 1949), Current Contents Connect (from 1998), Cochrane library, Google scholar, Science Direct, and Web of Science to January 2013. The search terms included “gastric outlet, gastroduodenal or duodenal obstruction’’, ‘‘gastrojejunostomy, gastroenterostomy or surgical bypass’’, and ‘‘endoscopic and stent”, which were searched as text word and as exploded medical subject headings where possible. No language restrictions were used in either the search or study selection. The reference lists of relevant articles were also searched for appropriate studies. A search for unpublished literature was not performed.