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Gastrojejunostomy versus endoscopic duodenal stent placement for gastric outlet obstruction in patients with unresectable pancreatic cancer: a propensity score-matched analysis

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Abstract

Background

Treatments for patients with gastric outlet obstruction (GOO) due to unresectable pancreatic cancers (URPC) include gastrojejunostomy (GJJ) and endoscopic duodenal stent placement (EDSP). This study compared the efficacy and safety of GJJ and EDSP in patients with GOO due to URPC.

Methods

This study retrospectively evaluated consecutive patients with GOO due to URPC who underwent GJJ or EDSP between April 2016 and March 2020. The efficacy and safety of GJJ and EDSP were compared with propensity score analysis. Subgroup analyses of overall survival (OS) were compared after propensity matching.

Results

Data were obtained from 54 patients who underwent GJJ and from 73 who underwent EDSP at five tertiary care hospitals. After propensity matching, OS was significantly longer in patients who underwent GJJ than EDSP (110 vs. 63 days, respectively; p = 0.019). Evaluation of long-term adverse events showed that the frequency of cholangitis and obstructive jaundice was significantly lower in the matched GJJ than in the matched EDSP group (p = 0.012). Subgroup analyses showed that OS in patients with good performance status (PS; p = 0.041), biliary obstruction (p = 0.007), and duodenal obstruction near the papilla (p = 0.027), and those receiving chemotherapy (p = 0.010), was significantly longer in the matched GJJ group than in matched EDSP group.

Conclusion

GJJ provides longer OS than EDSP for patients with GOO caused by URPC, especially for patients with good PS, biliary obstruction, and duodenal obstruction near the papilla, and those receiving chemotherapy.

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Acknowledgements

The authors thank all the members of the Second Department of Internal Medicine, Second Department of Surgery and Clinical Study Support Center at Wakayama Medical University, Department of Gastroenterology and Hepatology and Department of Surgery at Kindai University Faculty of Medicine, Department of Surgery and Department of Gastroenterology at Nara Medical University, Second Department of Internal Medicine and Department of general and gastroenterological surgery at Osaka Medical and Pharmaceutical University and Department of Surgery and Department of Medicine, Shiga University of Medical Science

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Authors and Affiliations

  1. Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama, 641-8509, Japan

    Takashi Tamura & Masayuki Kitano

  2. Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka-sayama, Japan

    Takenaka Mamoru & Shunsuke Omoto

  3. Department of Surgery, Nara Medical University, Nara, Japan

    Taichi Terai & Masayuki Sho

  4. Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan

    Takeshi Ogura & Saori Ueno

  5. Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan

    Masaji Tani & Hiromitsu Maehira

  6. Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan

    Toshio Shimokawa

  7. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

    Yuji Kitahata

  8. Department of Surgery, Faculty of Medicine, Kindai University, Osaka-sayama, Japan

    Ippei Matsumoto

  9. Department of Gastroenterology, Nara Medical University, Nara, Japan

    Akira Mitoro

  10. Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan

    Mitsuhiro Asakuma

  11. Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan

    Osamu Inatomi

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  1. Takashi Tamura
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  2. Takenaka Mamoru
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  3. Taichi Terai
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  4. Takeshi Ogura
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  9. Akira Mitoro
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  12. Shunsuke Omoto
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  13. Masayuki Sho
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  14. Saori Ueno
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  15. Hiromitsu Maehira
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  16. Masayuki Kitano
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Corresponding author

Correspondence to Masayuki Kitano.

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Disclosure

Masayuki Kitano has received honoraria from Olympus Corporation for delivering lectures at conferences and grants from Boston Scientific. Takashi Tamura, Takenaka Mamoru, Taichi Terai, Takeshi Ogura, Masaji Tani, Toshio Shimokawa, Yuji Kitahata, Ippei Matsumoto, Akira Mitoro, Mitsuhiro Asakuma, Osamu Inatomi, Shunsuke Omoto, Masayuki Sho, Saori Ueno and Hiromitsu Maehira have no conflict of interest or financial ties to disclose.

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Tamura, T., Mamoru, T., Terai, T. et al. Gastrojejunostomy versus endoscopic duodenal stent placement for gastric outlet obstruction in patients with unresectable pancreatic cancer: a propensity score-matched analysis. Surg Endosc 37, 1890–1900 (2023). https://doi.org/10.1007/s00464-022-09685-x

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  • DOI: https://doi.org/10.1007/s00464-022-09685-x

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