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Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction

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Abstract

Background and aims

Endoscopic placement of enteral self-expandable metallic stents is an alternative to surgical gastrojejunostomy (GJ) for palliation of malignant gastric outlet obstruction (GOO). Factors associated with clinical outcomes are not known. The aims of this study are to compare the overall complication rate and effectiveness (duration of oral intake) between endoscopic stenting (ES) and GJ in patients with GOO and identify predictors of clinical outcomes.

Patients and methods

This was a retrospective cohort study at a single tertiary academic center. Patients who underwent ES or GJ for treatment of GOO between 1/2001 and 12/2010 were identified using an institutional claims database. The electronic medical records for each patient were reviewed. Univariate and multivariate logistic regression analyses were performed to study the association of treatment outcomes with patient factors and cancer therapy.

Results

120 patients had ES while 227 had GJ. Technical success was higher for GJ (99 vs. 96 %, p = 0.004). Complication rates were higher in the GJ group (22.10 vs. 11.66 %, p = 0.02). Reintervention was more common with ES [adjusted odds ratio (OR) 9.18, p < 0.0001]. Mean length of hospital stay (LOHS) was shorter (adjusted p = 0.005) in the ES compared with the GJ group. However, mean hospital charges, including reinterventions, were greater in the ES group (US $34,250 vs. US $27,599, p = 0.03). ES and GJ had comparable reintervention-free time in patients who had reintervention (88 vs. 106 days, respectively, p = 0.79). Chemotherapy [adjusted hazard ratio (HR) 3 > 0.57, p = 0.04] and radiation therapy (adjusted HR 0.35, p = 0.03) were associated with significantly longer duration of oral intake after ES or GJ.

Conclusion

ES is associated with fewer complications, shorter LOHS, but higher reintervention rates and overall charges.

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Disclosures

Mouen A. Khashab is a consultant for Boston Scientific. Patrick Okolo is a consultant for Boston Scientific. Anthony Kalloo is a founding member, equity holder, and consultant for Apollo Endosurgery. Ahmad S. Alawad, Eun Ji Shin, Katherine Kim, Nicolas Bourdel, Vikesh K. Singh, Anne Marie Lennon, Susan Hutfless, Reem Z. Sharaiha, Stuart Amateau, Martin A. Makary, Christopher Wolfgang, and Marcia Irene Canto have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 1830 E. Monument Street, Room 424, Baltimore, MD, 21205, USA

    Mouen Khashab, Ahmad S. Alawad, Eun Ji Shin, Katherine Kim, Nicolas Bourdel, Vikesh K. Singh, Anne Marie Lennon, Susan Hutfless, Reem Z. Sharaiha, Stuart Amateau, Patrick I. Okolo, Marcia Irene Canto & Anthony N. Kalloo

  2. Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA

    Martin A. Makary & Christopher Wolfgang

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  1. Mouen Khashab
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Correspondence to Mouen Khashab.

Additional information

Mouen Khashab and Ahmad S. Alawad contributed equally to this work.

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Khashab, M., Alawad, A.S., Shin, E.J. et al. Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 27, 2068–2075 (2013). https://doi.org/10.1007/s00464-012-2712-7

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