4749 Endoscopic versus surgical palliation of malignant gastric outlet obstruction: a retrospective analysis.

Abstract

Background: Palliation of malignant gastric outlet obstruction is usually achieved surgically. Recently, endoscopic palliation using expandable metal stents has been employed with good anecdotal success. Aim: To compare clinical success rates, hospitalization days, and treatment costs of endoscopic versus surgical approaches to palliation of malignant gastric outlet obstruction. Methods: Over the last 12 months, 10 consecutive patients underwent placement of expandable metal stents (enteral Wallstent, 20 or 22mm diameter) for palliation of malignant gastric oultet obstruction. These patients were compared with an equal number of patients who underwent open surgical gastrojejunostomy. The surgical patients were randomly selected from a surgical billing database from the last four years. Patients and/or families in both groups were interviewed by phone using a symptom questionnaire. Successful palliation was defined as ability to maintain adequate oral intake without need for parenteral supplementation. Medical records were reviewed to determine hospital days from the time of intervention to initial discharge. Cost of palliation was determined by adding hospital day and procedural costs. The distribution of underlying malignancies was similar in the two groups. Nonparametric methods were used to compare hospital days and costs between the two groups. Results: No statistically significant difference in clinical success rates was demonstrable given small sample sizes. Endoscopically treated patients had significantly shorter hospitalizations (p