European Radiology

, Volume 26, Issue 8, pp 2436–2445 | Cite as

Gastroduodenal stent placement versus surgical gastrojejunostomy for the palliation of gastric outlet obstructions in patients with unresectable gastric cancer: a propensity score-matched analysis

  • Jung-Hoon Park
  • Ho-Young Song
  • Sung-Cheol Yun
  • Moon-Won Yoo
  • Min-Hee Ryu
  • Jin Hyoung Kim
  • Do Hoon Kim
  • Jeong Hoon Lee
  • Wei-Zhong Zhou
  • Jeong Hwan Yook
  • Hwoon-Yong Jung
Vascular-Interventional

Abstract

Objectives

To compare the outcomes between stent placement and surgical gastrojejunostomy (GJ) for the palliation of gastric outlet obstruction (GOO) in patients with unresectable gastric cancer.

Methods

A retrospective study was performed in a single university hospital in 224 patients with GOO, and who were treated either by stent placement (n = 124) or surgical GJ (n = 100). The outcomes were assessed with reference to the following variables with the use of propensity-score matching: success rates; complications; dysphagia scores, albumin, and body mass index; survival; symptom-free duration; and hospitalization.

Results

We identified a well-balanced cohort of 74 pairs of patients, matched on the basis of propensity score. The dysphagia score 7 days after treatment was significantly better in the stent group (P < 0.001). Albumin level 1 month after treatment was significantly lower in the stent group (P < 0.001). Symptom-free duration and hospitalization were significantly longer in the surgery group (P = 0.002, P < 0.001, respectively). The recurrence rate was significantly higher in the stent group (P = 0.032).

Conclusions

Stent placement can provide faster symptom relief and shorter hospitalization, while surgical GJ can provide longer symptom-free duration, less recurrent obstruction symptoms and better nutritional status.

Key Points

The two methods are equally effective in palliating gastric outlet obstruction symptoms

The stent group showed rapid and efficient palliation of symptoms

Recurrent symptoms were more frequent in the stent group

Surgical gastrojejunostomy provides a longer symptom-free duration and better nutritional status

Keywords

Gastric outlet obstruction Gastric bypass Stents Stomach neoplasms Dysphagia 

Abbreviations

BMI

Body mass index

ECOG

Eastern Cooperative Oncology Group

GJ

Gastrojejunostomy

GOO

Gastric outlet obstruction

SEMS

Self-expandable metallic stent

Notes

Acknowledgements

The scientific guarantor of this publication is Ho-Young Song, M.D. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This research was supported by the Basic Science Research Program through the National Research Foundation of Republic of Korea (NRF), funded by the Ministry of Science, ICT and Future Planning (NRF-2014R1A2A2A04006562). Sung-Cheol Yun, Ph.D. kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Jung-Hoon Park
    • 1
  • Ho-Young Song
    • 1
  • Sung-Cheol Yun
    • 2
  • Moon-Won Yoo
    • 3
  • Min-Hee Ryu
    • 4
  • Jin Hyoung Kim
    • 1
  • Do Hoon Kim
    • 5
  • Jeong Hoon Lee
    • 5
  • Wei-Zhong Zhou
    • 1
    • 6
  • Jeong Hwan Yook
    • 3
  • Hwoon-Yong Jung
    • 5
  1. 1.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Clinical Epidemiology and Biostatistics, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of General Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  4. 4.Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  5. 5.Department of Gastroenterology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  6. 6.Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina

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