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Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction

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Abstract

Background

We prospectively compared laparoscopic gastrojejunostomy with duodenal stenting as a means of palliating malignant gastric outflow obstruction.

Methods

A total of 27 patients with malignant gastric outflow obstruction were randomized to either laparoscopic gastrojejunostomy (LGJ) or duodenal stenting (DS) over a 3-year period.

Results

Thirteen patients underwent successful LGJ and 10 had successful DS. Eight patients had complications after LGJ, but none had complications after DS. Patients who underwent LGJ had a significant increase in visual analog pain score at day 1 (p = 0.05), and also had a longer hospital stay compared to those who underwent DS (11.4 vs. 5.2 days, p = 0.02). After DS, patients experienced an improvement in physical health at 1 month as measured using the Short Form-36 (SF-36) questionnaire (p < 0.01). There was no change following LGJ.

Conclusion

Duodenal stenting is a safe means of palliating malignant gastric outflow obstruction. It offers significant advantages for patients compared with minimal-access surgery.

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References

  1. Alam TA, Baines M, Parker MC (2003) The management of gastric outlet obstruction secondary to inoperable cancer. An evaluation of Laparoscopic gastrojejunostomy. Surg Endosc 17: 320–323

    Article  CAS  PubMed  Google Scholar 

  2. Bozzetti F, Bonfanti G, Audisio RA, Doci R, Dossena G, Gennari L, Andreola S (1987) Prognosis of patients after palliative surgical procedures for cancer of the stomach. Surg Gynecol Obstet 164: 151–154

    CAS  PubMed  Google Scholar 

  3. Choi YB (2002) Laparoscopic gastrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer. Surg Endosc 16: 1620–1626

    Article  PubMed  Google Scholar 

  4. Davies N, Thomas HG, Eyre-Brook IA (1998) Palliation of dysphagia from inoperable oesophageal carcinoma using Atkinson tubes or self-expanding metal stents. Ann R Coll Surg Engl 80(6): 394–397

    CAS  PubMed  Google Scholar 

  5. De Baere T, Harry G, Ducreux M, Elias D, Briquet R, Kuoch V, Roche A (1997) Self-expanding metallic stents as palliative treatment of malignant gastroduodenal stenosis. Am J Roentgenol 169(4): 1079–1083

    Google Scholar 

  6. Dormann A, Meisner S, Verin N, Wenk Lang A (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36: 543–550

    Article  CAS  PubMed  Google Scholar 

  7. Jenkinson C, Layte R, Lawrence K (1997) Development and testing of the SF-36 summary scale scores in the United Kingdom: results from a large scale survey and a clinical trial. Med Care 35: 410–416

    CAS  PubMed  Google Scholar 

  8. Jung GS, Song HY, Kang SG, Huh JD, Park SJ, Koo JY, Choi YD (2000) Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology 216(3): 758–763

    CAS  PubMed  Google Scholar 

  9. Kaw M, Singh S, Gagneja H, Azad P (2003) Role of self-expanding metal stents in the palliation of malignant duodenal obstruction. Surg Endosc 17: 646–650

    CAS  PubMed  Google Scholar 

  10. Nagy A, Brosseuk D, Hemming A, Scudamore C, Mamazza J (1995) Laparoscopic gastroenterostomy for duodenal obstruction. Am J Surg 169(5): 539–542

    Article  CAS  PubMed  Google Scholar 

  11. Rhodes M, Nathanson L, Fielding G (1995) Laparoscopic biliary and gastric bypass: a useful adjunct in the treatment of carcinoma of the pancreas. Gut 36: 778–780

    CAS  PubMed  Google Scholar 

  12. Tang T, Allison M, Dunkley I, Roberts P, Dickinson R (2003) Enteral stenting in 21 patients with malignant gastroduodenal obstruction. J R Soc Med 96(10): 494–496

    Article  PubMed  Google Scholar 

  13. Weaver DW, Wiencek RG, Bouwman DL, Walt AJ (1987) Gastrojejunostomy: is it helpful for patients with pancreatic cancer? Surgery 102: 608–613

    CAS  PubMed  Google Scholar 

  14. Yim HB, Jacobson BC, Saltzman JR, Johannes RS, Bounds BC, Lee JH, Shields SJ, Ruymann FW, Van Dam J, Carr-Locke DL (2001) Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 53(3):329–332

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, England, United Kingdom

    S. Mehta, A. Hindmarsh, E. Cheong, R. Tighe, M. P. N. Lewis & M. Rhodes

  2. Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, England, United Kingdom

    J. Cockburn & J. Saada

Authors
  1. S. Mehta
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  2. A. Hindmarsh
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  3. E. Cheong
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  4. J. Cockburn
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  5. J. Saada
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  6. R. Tighe
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  7. M. P. N. Lewis
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  8. M. Rhodes
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Correspondence to M. Rhodes.

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Mehta, S., Hindmarsh, A., Cheong, E. et al. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc 20, 239–242 (2006). https://doi.org/10.1007/s00464-005-0130-9

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  • DOI: https://doi.org/10.1007/s00464-005-0130-9

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