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A systematic review of methods to palliate malignant gastric outlet obstruction
Surgical Endoscopy, 07/01/09

Ly J et al. - This review demonstrates improved clinical outcomes with ES over OGJ for patients with malignant GOO. However, there is insufficient data to adequately compare ES with LGJ, which is the current standard for operative management. As these conclusions are based on observational studies only, future large well-designed randomised controlled trials would be required to ensure the estimates of the relative efficacy of these interventions are valid.

Exclusive Author Commentary
John A. Windsor, 07/01/09

The benefits of ES in our own practice has been a revelation and is now our preferred approach to the palliative management of pyloric and duodenal malignant obstruction. And this is despite being enitrely comfortable with the technique of stapled laparoscopic gastro-jejunostomy. With the latter we take down the momentum and perform a antecolic, distal and posterior gastro-jejunostomy, which is the preferred approach. While strictly speaking, in the absence of level 1 evidence there is still equipoise, in reality and as a result of our positive experience with ES, it would be difficult for us to randomize a patient to laparoscopic gastro-jejunostomy arm.

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