Digestive Diseases and Sciences

, Volume 52, Issue 1, pp 276–281 | Cite as

Surgical Bypass Versus Endoscopic Stenting for Malignant Gastroduodenal Obstruction: A Decision Analysis

  • Ali SiddiquiEmail author
  • Stuart J. Spechler
  • Sergio Huerta
Original Article


The treatment options for palliating malignant gastroduodenal obstruction include open gastrojejunostomy (OGJ), laparoscopic gastrojejunostomy (LGJ), and endoscopic stenting (ES). The aim of this study was to compare the clinical outcomes and costs among ES, OGJ, and LGJ in patients who present with gastroduodenal obstruction from advanced upper gastrointestinal tract cancer. We designed a model for patients with malignant gastroduodenal obstruction. We analyzed success rates, complication rates and costs of the three treatment modalities: ES, OGJ, and LGJ. Baseline outcomes and costs were based on published reports. Success was defined as no major procedure-related and long-term complications over a 1-month period. Failure of therapy was defined as recurrent symptoms or death due to a procedural complication. Sensitivity analyses and cost-effectiveness analyses for the various strategies were performed. ES resulted in the lowest mortality rate and the lowest cost of the three treatment options analyzed. Mortality in the OGJ group was 2.1 times that in the ES cohort and 1.8 times that in the LGJ cohort. Sensitivity analyses confirmed ES as the dominant strategy. In conclusion, ES is the preferred treatment for palliation of duodenal obstruction due to advanced upper gastrointestinal tract cancer.


Pancreatic cancer Gastric cancer Duodenal cancer Duodenal obstruction Gastric outlet obstruction Self-expanding metal stents Open gastrojejunostomy Laparoscopic gastrojejunostomy 


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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Ali Siddiqui
    • 1
    • 3
    Email author
  • Stuart J. Spechler
    • 1
  • Sergio Huerta
    • 2
  1. 1.Division of GastroenterologyVA North Texas Health Care System and University of Texas Southwestern Medical SchoolDallasUSA
  2. 2.Division of GI/Endocrine SurgeryVA North Texas Health Care System and University of Texas Southwestern Medical SchoolDallasUSA
  3. 3.Division of GastroenterologyVA North Texas Health Care System (111B1)DallasUSA

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