Colocación de cánulas versus paliación quirúrgica para adultos con obstrucción maligna de la salida gástrica
Información
- DOI:
- https://doi.org/10.1002/14651858.CD012506.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 30 mayo 2018see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Salud digestiva
- Copyright:
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- Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Conceiving the review: EU.
Designing the review: EU.
Co‐ordinating the review: EU.
Designing search strategies and analysing the results: EU, RC.
Writing the review: EU.
Assessing the review: RC, MR.
Sources of support
Internal sources
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Gloucestershire Hospitals NHS Foundation Trust, UK.
External sources
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No sources of support supplied
Declarations of interest
This report is independent research funded by the National Institute for Health Research (NIHR Cochrane Programme Grants, 13/89/03 ‐ Evidence‐based diagnosis and management of upper digestive, hepatobiliary and pancreatic disorders). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.
EU: none known.
MR: none known.
RC: none known.
Acknowledgements
We would like to thank Karin Dearness, Managing Editor, Cochrane Upper Gastrointestinal and Pancreatic Diseases Group (UGPD) for providing administrative and logistical support for the conduct of the current review, and Yuhong Yuan, Trials Search Co‐ordinator, Cochrane UGPD Group for developing and executing the search strategies.
We would also like to thank the peer reviewers, copy editors and Cochrane Editorial Unit for their comments.
Version history
| Published | Title | Stage | Authors | Version |
| 2018 May 30 | Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction | Review | Emma Upchurch, Mark Ragusa, Roberto Cirocchi | |
| 2017 Jan 26 | Stent placement versus surgical palliation for malignant gastric outlet obstruction | Protocol | Emma Upchurch, Roberto Cirocchi, Mark Ragusa | |
Differences between protocol and review
We included additional outcome measures of median survival, minor adverse events and need for reintervention.
We measure technical success as not all studies included time to resumption of oral intake. Therefore, this was used as an additional measure to compare the two methods.
It became clear that the three studies utilised different definitions for adverse events and, thus, we included minor as well as the planned serious adverse events to ensure all negative outcomes were recorded.
We added the need for reintervention as an additional secondary outcome as this was not always included as an adverse event. Further interventions would add additional risks and would impact the quality of life of the participants. The outcome of 'time to recurrence of obstructive symptoms' was not reported, but rather the presence or absence of recurrence symptoms.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Humans;
PICO
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 1 Re‐establishment of oral intake (technical success of the intervention).
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 2 Time to re‐establishment of oral intake (days).
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 3 All‐cause mortality.
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 4 Median survival postintervention (days).
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 5 Time to recurrence of obstructive symptoms.
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 6 Serious adverse events.
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 7 Serious adverse events: need for reintervention.
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 8 Minor adverse events.
Comparison 1 Surgical palliation versus duodenal stenting, Outcome 9 Length of hospital stay (days).
| Duodenal stenting compared with surgical palliation for malignant gastric outlet obstruction | |||||
| Patient or population: people with malignant gastric outlet obstruction Setting: hospital Intervention: duodenal stent placement Comparison: surgical palliation | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | |
| Assumed risk | Corresponding risk | ||||
| Surgical palliation | Duodenal stent | ||||
| Re‐establishment of oral intake (technical success of the intervention) Follow‐up: 1 to 30 days | 975 per 1000 | 956 per 1000 | RR 0.98 (0.88 to 1.09) | 82 | ⊕⊕⊝⊝ |
| Time to re‐establishment of oral intake Follow‐up: 1 to 30 days | 7.6 days | The mean time to oral intake in the duodenal stent group was 3.07 days shorter | MD ‐3.07 days (‐4.76 to ‐1.39) | 57 | ⊕⊕⊝⊝ |
| All‐cause mortality Follow‐up: 1 to 30 days | 214 per 1000 | 154 per 1000 | RR 0.72 (0.14 to 3.64) | 27 | ⊕⊝⊝⊝ |
| Median survival postintervention Follow‐up: 1 to 975 days | 78 days | The median survival in the duodenal stent group was | MD ‐22.00 days (‐53.45 to 9.45) | 39 | ⊕⊝⊝⊝ |
| Time to recurrence of obstructive symptoms Follow‐up: 1 to 975 days | 37 per 1000 | 188 per 1000 | RR 5.08 (0.96 to 26.74) | 57 | ⊕⊕⊕⊝ |
| Adverse events Follow‐up: 1 to 30 days | Serious adverse events | RR 1.15 (0.33 to 3.98) | 84 | ⊕⊝⊝⊝ | |
| 98 per 1000 | 112 per 1000 | ||||
| Serious adverse events (need for reintervention) | RR 4.71 (1.36 to 16.30) | 84 | ⊕⊝⊝⊝ | ||
| 49 per 1000 | 230 per 1000 | ||||
| Minor adverse events | RR 0.35 (0.07 to 1.61) | 84 | ⊕⊝⊝⊝ | ||
| 341 per 1000 | 120 per 1000 | ||||
| Length of hospital stay Follow‐up: 1 to 30 days | 12.9 days | The mean length of hospital stay in the duodenal stent group was 6.70 days shorter | MD ‐6.70 days (9.41 lower to 3.98 lower) | 84 | ⊕⊕⊕⊝ |
| Health‐related quality of life | Studies used different methods to assess quality of life in the included studies so the data could not be combined. | ||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; RR: risk ratio. | |||||
| GRADE Working Group grades of evidence | |||||
| 1Unclear or high risk bias within the studies (very serious concerns) (downgraded by two levels). 2Unclear or high risk of bias within the studies (downgraded by two levels) in addition to very serious inconsistencies between the studies (downgraded by two levels). 3Some imprecision in the results as exemplified by the large confidence intervals (downgraded by one level). 4Confidence intervals were wide (overlapped no effect and clinically significant effect) and the sample size was small (downgraded by two levels). 5Serious inconsistencies between the studies (downgraded by one level). | |||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Re‐establishment of oral intake (technical success of the intervention) Show forest plot | 3 | 82 | Risk Ratio (M‐H, Random, 95% CI) | 0.98 [0.88, 1.09] |
| 2 Time to re‐establishment of oral intake (days) Show forest plot | 2 | 57 | Mean Difference (IV, Random, 95% CI) | ‐3.07 [‐4.76, ‐1.39] |
| 3 All‐cause mortality Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 4 Median survival postintervention (days) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 5 Time to recurrence of obstructive symptoms Show forest plot | 2 | 57 | Risk Ratio (M‐H, Random, 95% CI) | 5.08 [0.96, 26.74] |
| 6 Serious adverse events Show forest plot | 3 | 84 | Risk Ratio (M‐H, Random, 95% CI) | 1.15 [0.33, 3.98] |
| 7 Serious adverse events: need for reintervention Show forest plot | 3 | 84 | Risk Ratio (M‐H, Random, 95% CI) | 4.71 [1.36, 16.30] |
| 8 Minor adverse events Show forest plot | 3 | 84 | Risk Ratio (M‐H, Random, 95% CI) | 0.35 [0.07, 1.61] |
| 9 Length of hospital stay (days) Show forest plot | 3 | 84 | Mean Difference (IV, Random, 95% CI) | ‐6.70 [‐9.41, ‐3.98] |
