Abstract

BackgroundGastrojejunostomy (GJJ) is the most commonly used palliative treatment modality for malignant gastric outlet obstruction. Recently, stent placement has been introduced as an alternative treatment. We reviewed the available literature on stent placement and GJJ for gastric outlet obstruction, with regard to medical effects and costs.MethodsA systematic review of the literature was performed by searching PubMed for the period January 1996 and January 2006. A total of 44 publications on GJJ and stents was identified and reported results on medical effects and costs were pooled and evaluated. Results from randomized and comparative studies were used for calculating odds ratios (OR) to compare differences between the two treatment modalities.ResultsIn 2 randomized trials, stent placement was compared with GJJ (with 27 and 18 patients in each trial). In 6 comparative studies, stent placement was compared with GJJ. Thirty-six series evaluated either stent placement or GJJ. A total of 1046 patients received a duodenal stent and 297 patients underwent GJJ. No differences between stent placement and gastrojejunostomy were found in technical success (96% vs. 100%), early and late major complications 7% vs. 6% and 18% vs. 17%, respectively) and persisting symptoms (8% vs. 9%). Initial clinical success was higher after stent placement (89% vs. 72%). Minor complications were less frequently seen after stent placement in the patient series (9% vs. 33%), however the pooled analysis showed no differences (OR: 0.75, p = 0.8). Recurrent obstructive symptoms were more common after stent placement (18% vs. 1%). Hospital stay was prolonged after GJJ compared to stent placement (13 days vs. 7 days). The mean survival was 105 days after stent placement and 164 days after GJJ.ConclusionThese results suggest that stent placement may be associated with more favorable results in patients with a relatively short life expectancy, while GJJ is preferable in patients with a more prolonged prognosis. The paucity of evidence from large randomized trials may however have influenced the results and therefore a trial of sufficient size is needed to determine which palliative treatment modality is optimal in (sub)groups of patients with malignant gastric outlet obstruction.

Highlights

  • Gastrojejunostomy (GJJ) is the most commonly used palliative treatment modality for malignant gastric outlet obstruction

  • The results showed no difference in technical success rate between stent placement and GJJ (OR: 0.22, confidence interval (CI): 0.02–2.1, p = 0.2)

  • The results of this review suggest that patients with a duodenal stent have a shorter hospital stay, a more frequent and faster relief of obstructive symptoms, which may be associated with fewer minor complications than those treated with a GJJ

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Summary

Introduction

Gastrojejunostomy (GJJ) is the most commonly used palliative treatment modality for malignant gastric outlet obstruction. We reviewed the available literature on stent placement and GJJ for gastric outlet obstruction, with regard to medical effects and costs. Gastric Outlet Obstruction (GOO) is a common symptom in patients with cancer of the distal stomach, duodenum and pancreas. Open gastrojejunostomy (GJJ) has been the standard palliative treatment in these patients. Open GJJ is associated with a good functional outcome and relieves symptoms in almost all patients. Laparoscopic GJJ has been introduced as an alternative to open GJJ to relieve symptoms of malignant GOO. Laparoscopic GJJ has been reported to be less invasive and to be associated with a faster recovery compared to open GJJ, mortality and morbidity of the procedure remain high [3,6,11,12]

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