Table 115Summary clinical evidence profile for Type I GJJ (proximal to the Jejunal limb: Ligament of Treitz) versus Type II GJJ (Pylorus) in adults with pancreatic cancer and gastric outlet obstruction

OutcomesIllustrative comparative risks* (95% CI)Relative effect (95% CI)No of Participants (studies)Quality of the evidence (GRADE)Comments
Assumed riskCorresponding risk
Type II GJJ PylorusType I GJJ proximal to the Jejunal limb: Ligament of Treitz
Change in symptoms - GOO overall GOO Follow-up: 1 months133 per 1000467 per 1000
(115 to 1000)
RR 3.5
(0.86 to 14.18)
30
(1 study)
⊕⊝⊝⊝
very low1,2,3
Change in symptoms (GOO) - Anorexia GOO Follow-up: 1 months0 per 10000 per 1000
(0 to 0)
RR 3
(0.13 to 68.26)
30
(1 study4)
⊕⊝⊝⊝
very low1,2,5
Change in symptoms (GOO) - Epigastric fullness GOO Follow-up: 1 months67 per 1000133 per 1000
(13 to 1000)
RR 2
(0.2 to 19.78)
30
(1 study4)
⊕⊝⊝⊝
very low1,2,5
Change in symptoms (GOO) - Nausea GOO Follow-up: 1 months0 per 10000 per 1000
(0 to 0)
RR 3
(0.13 to 68.26)
30
(1 study4)
⊕⊝⊝⊝
very low1,2,5
Change in symptoms (GOO) - Vomiting GOO Follow-up: 1 months0 per 10000 per 1000
(0 to 0)
RR 7
(0.39 to 124.83)
30
(1 study4)
⊕⊝⊝⊝
very low1,2,5
Nutritional status - Gastric emptying time Follow-up: 1 monthsThe mean nutritional status - gastric emptying time in the control groups was
118.1 min
The mean nutritional status - gastric emptying time in the intervention groups was
40.8 higher
(67.85 lower to 149.45 higher)
30
(1 study4)
⊕⊝⊝⊝
very low1,2,6,7
Nutritional status - Patients with delayed gastric emptying Follow-up: 10 days67 per 1000200 per 1000
(23 to 1000)
RR 3
(0.35 to 25.68)
30
(1 study4)
⊕⊝⊝⊝
very low1,2
*

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; RR: Risk ratio;

1

Quality of evidence was downgraded by 1 point owing to unclear risk of performance bias and unclear selective reporting

2

Sample had <66% pancreatic cancer patients.

3

95% CI crosses 1 default MID (0.8 or 1.25).

4
5

95% CI crosses 2 default MIDs (0.8 and 1.25).

6

MIDs for nutritional status (gastric emptying time) were calculated as +/- SD of control group immediately after resumption of oral diet and was +/- 75.91 min.

7

95% CI crosses 1 MID for this outcome.

From: 9, Interventions to relieve biliary and duodenal obstruction

Cover of Pancreatic cancer in adults: diagnosis and management
Pancreatic cancer in adults: diagnosis and management.
NICE Guideline, No. 85.
National Guideline Alliance (UK).
Copyright © NICE 2018.

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