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



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.


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.


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).


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


Gastric outlet obstruction Gastric bypass Stents Stomach neoplasms Dysphagia 



Body mass index


Eastern Cooperative Oncology Group




Gastric outlet obstruction


Self-expandable metallic stent



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.


  1. 1.
    Keränen I, Kylänpää L, Udd M et al (2013) Gastric outlet obstruction in gastric cancer: a comparison of three palliative methods. J Surg Oncol 108:537–541CrossRefPubMedGoogle Scholar
  2. 2.
    Del Piano M, Ballare M, Montino F et al (2005) Endoscopy or surgery for malignant GI outlet obstruction? Gastrointest Endosc 61:421–426CrossRefPubMedGoogle Scholar
  3. 3.
    Jung GS, Song HY, Kang SG et al (2000) Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology 216:758–763CrossRefPubMedGoogle Scholar
  4. 4.
    Tringali A, Didden P, Repici A et al (2014) Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study. Gastrointest Endosc 79:66–75CrossRefPubMedGoogle Scholar
  5. 5.
    Park KB, Do YS, Kang WK et al (2001) Malignant obstruction of gastric outlet and duodenum: palliation with flexible covered metallic stents. Radiology 219:679–683CrossRefPubMedGoogle Scholar
  6. 6.
    Baron TH, Harewood GC (2003) Enteral self-expandable stents. Gastrointest Endosc 58:421–433CrossRefPubMedGoogle Scholar
  7. 7.
    No JH, Kim SW, Lim CH et al (2013) Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc 78:55–62CrossRefPubMedGoogle Scholar
  8. 8.
    Jeurnink SM, Steyerberg EW, van Hooft JE et al (2010) Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 71:490–499CrossRefPubMedGoogle Scholar
  9. 9.
    Roy A, Kim M, Christein J, Varadarajulu S (2012) Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: comparison of clinical outcomes and costs. Surg Endosc 26:3114–3119CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Khashab M, Alawad AS, Shin EJ et al (2013) Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 27:2068–2075CrossRefPubMedGoogle Scholar
  11. 11.
    Mehta S, Hindmarsh A, Cheong E et al (2006) Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc 20:239–242CrossRefPubMedGoogle Scholar
  12. 12.
    Hosono S, Ohtani H, Arimoto Y, Kanamiya Y (2007) Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol 42:283–290CrossRefPubMedGoogle Scholar
  13. 13.
    Nagaraja V, Eslick GD, Cox MR (2014) Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction: a systematic review and meta-analysis of randomized and non-randomized trials. J Gastrointest Oncol 5:92–98PubMedPubMedCentralGoogle Scholar
  14. 14.
    Song HY, Shin JH, Yoon CJ et al (2004) A dual expandable nitinol stent: experience in 102 patients with malignant gastroduodenal strictures. J Vasc Interv Radiol 15:1443–1449CrossRefPubMedGoogle Scholar
  15. 15.
    Kim JH, Song HY, Shin JH et al (2007) Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 66:256–264CrossRefPubMedGoogle Scholar
  16. 16.
    D’Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17:2265–2281CrossRefPubMedGoogle Scholar
  17. 17.
    Rosenbaum PR (1995) Observational studies. Springer-Verlag, New YorkCrossRefGoogle Scholar
  18. 18.
    Song M, Song HY, Kim JH et al (2011) Food impaction after expandable metal stent placement: experience in 1,360 patients with esophageal and upper gastrointestinal tract obstruction. J Vasc Interv Radiol 22:1293–1299CrossRefPubMedGoogle Scholar
  19. 19.
    Kim JH, Song HY, Shin JH et al (2009) Metallic stent placement in the palliative treatment of malignant gastric outlet obstructions: primary gastric carcinoma versus pancreatic carcinoma. AJR Am J Rentgenol 193:241–247CrossRefGoogle Scholar
  20. 20.
    Park JH, Song HY, Kim MS et al (2013) Usefulness of a guiding sheath for fluoroscopic stent placement in patients with malignant gastroduodenal obstruction. Acta Radiol 54:267–271CrossRefPubMedGoogle Scholar

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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