Summary of findings for the main comparison. Prophylactic gastrojejunostomy for unresectable periampullary carcinoma.
| Prophylactic gastrojejunostomy for unresectable periampullary carcinoma | ||||||
| Patient or population: patients with unresectable periampullary carcinoma Settings: inpatients Intervention: Prophylactic gastrojejunostomy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Prophylactic gastrojejunostomy | |||||
| Survival Follow‐up: 6 to 9 months | 40 per 1001 | 41 per 100 (35 to 48)1 | HR 1.02 (0.84 to 1.25) | 152 (2 studies) | ⊕⊝⊝⊝ very low2,3 | There was no difference in the long‐term survival between the patients undergoing prophylactic gastrojejunostomy and those who did not. |
| Gastric outlet obstruction Clinical symptoms of vomiting with confirmation of the gastric outlet obstruction by radiological or endoscopic investigations Follow‐up: 6 months | 28 per 100 | 3 per 100 (1 to 10) | RR 0.1 (0.03 to 0.37) | 152 (2 studies) | ⊕⊝⊝⊝ very low2,3,4 | Gastric outlet obstruction was significantly reduced in those undergoing gastrojejunostomy. |
| Operating time | The mean operating time in the control groups was 209 minutes | The mean operating time in the intervention groups was 45 minutes longer (21.39 to 68.61 longer) | 87 (1 study) | ⊕⊝⊝⊝ very low2,3,4 | The operating time was 45 minutes longer in the gastrojejunostomy group than the control group. | |
| *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; HR: Hazard ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 At six to nine months approximately 40% of patients in the control group were dead. This is equivalent to about 29 patients. Since all the included patients were followed until death, there was no censoring of patients and the figure is of actual survival of patients rather than actuarial survival. 2 Three patients in one trial were excluded from the trial report because of loss to follow‐up. 3 Small numbers of events 4 The existence or method of blinding was not reported in either trial.