Treatment of malignant gastric outlet obstruction: endoscopic implantation of self-expanding metal stents versus gastric bypass surgery

Abstract

BACKGROUND: Palliative gastroenteric bypass surgery, the mainstay in the treatment of gastric outlet obstruction, has several disadvantages, including significant morbidity and mortality rates, and is frequently associated with delayed gastric emptying. Endoscopic stenting is reported to be an efficient and less invasive procedure for the symptomatic treatment of malignant GI tract obstruction. This study compares the outcomes of gastroenteric bypass surgery and endoscopic stenting. METHODS: We retrospectively analyzed 22 patients who underwent palliative endoscopic stenting of malignant gastric outlet obstruction or malignant obstruction in the upper part of the jejunum and compared them with 17 patients treated with palliative gastric bypass surgery during the same period. RESULTS: Obstructive symptoms improved in all 22 patients (100%) after endoscopic stenting compared to 11 of 17 patients (64.5%) after palliative gastric bypass surgery. The stent patients had a shorter hospital stay (4 days vs. 13 days), tolerated oral nutrition earlier (1 day vs. 6 days), had lower costs for hospital treatment (€ 2143 vs. € 6617) and had no procedure-related mortality after stent implantation (0/22 vs. 3/17). The differences in hospital stay, in improvement of symptoms, in time until resumption of oral nutrition and in hospital charges were statistically significant (p < 0.05). CONCLUSIONS: Endoscopic stent implantation, as palliative treatment for malignant gastric outlet obstruction or malignant stenosis in the upper part of the jejunum, is a highly effective, extremely safe and cost-efficient method. It should be the first choice in the treatment of malignant obstruction in this part of the GI tract.