Abstract
Objective: Palliative treatment of malignant gastroduodenal obstruction has been performed traditionally with gastrojejunostomy. Palliation with autoexpandable metal prostheses has also shown to be effective and to improve the quality of life of patients. We compared the effectiveness of conventional gastrojejunostomy with the application of an autoexpandable metal stent developed locally, for palliation of malignant gastroduodenal obstruction by evaluating clinical success, morbidity, mortality and length of hospital stay. Materials and Methods: Medical records from 80 patients with malignant gastroduodenal obstruction were reviewed: 40 patients had received treatment with the autoexpandable metal stent and 40 with gastrojejunostomy. Patients who underwent prophylactic gastrojejunostomy were excluded. Results: Gastroduodenal stents were successfully placed in 39 of 40 (97%) patients (21 males) and gastrojejunostomy was performed in 40 patients (23 men) with obstructive tumors of the gastroduodenal tract. The gastroduodenal obstruction was secondary to gastric, gallbladder or biliary tract, pancreatic and ampullary tumors or metastatic disease. These malignancies were considered unresectable in all patients. There were no statistical differences in the origin of the obstruction, hospital mortality or survival between the treatment groups. However, time to resume oral feeding (1.6 vs 7 days) and length of hospital stay (3 vs 14 days) were significantly shorter in the group receiving the stents (p < 0.01). Furthermore, morbidity was significantly lower in the stent group (15% vs 38%, p < 0,01). There was a trend in a higher activity index in the stent group (p = 0.08). Conclusions: The placement of autoexpandable metal stents was more beneficial in terms of length of hospital stay, time to resume oral feeding and morbidity than open gastrojejunostomy for the palliation of malignant gastroduodenal obstruction.
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