Abstract
Background
Malignant gastrointestinal obstruction is a secondary complication of cancers in an advanced state. Treatment has consisted of gastrojejunostomy. However, the endoscopic placement of metallic stents has provided positive results. This study aimed to compare the efficiency of both therapeutic options.
Methods
A total of 41 patients with gastrointestinal obstruction caused by inoperable neoplasm were treated endoscopically with enteral stent (24 patients) or gastrojejunostomy (17 patients).
Results
In the endoscopic group (EG) 24 patients (100%) achieved efficient gastric emptying, as compared with 82.3% in the surgical group (SG). The difference was not significant. The average time for initiating oral food tolerance was 2.4 days for the EG and 5 days for the SG (p < 0.001). The average inpatient time was 7.1 days for the EG and 11.5 days for the SG (p < 0.001). Mortality at 30 days was lower in the EG (16.6%) than in the SG (29.4%) (p < 0.05). The survival time was 20 weeks for the EG and 21.6 weeks for the SG. The difference was not significant. The rate of complications was 4% in the (EG) and 17.6% in the (SG), with the difference was not significant.
Conclusion
Endoscopic treatment of malignant gastrointestinal obstruction provides an adequate palliation of the symptoms. It is less invasive, avoids the morbidity associated with open gastrojejunostomy, and achieves a faster start to oral food and a shorter hospital stay, leading to a higher quality of life.
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References
Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97: 72–78
Del Piano M, Ballare M, Montino F, Todesco A, Orsello M, Magnani C, Garello E (2005) Endoscopy or surgery for malignant GI outlet obstruction?. Gastrointest Endosc 61: 421–426
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
Espinel J, Jorquera F, Dominguez AB, Lopez D, Suarez P, Bailador C, Alvarez M, Olcoz JE (2005) Enteral prostheses for palliative treatment of gastroduodenal obstruction: endoscopic procedure. Nutr Hosp 20: 132–135
Espinel J, Vivas S, Muñoz F, Jonquera F, Olcoz JL (2001) Palliative treatment of malignant obstruction of gastric outlet using an endoscopically placed enteral Wallstent. Dig Dis Sci 46: 2322–2324
Feretis C, Benakis P, Dimopoulos C, Georgopoulos K, Milas F, Manouras A, Apostolidis N (1996) Palliation of malignant gastric outlet obstruction with self-expanding metal stents. Endoscopy 28: 225–228
Fiori E, Lamazza A, Volpino P, Burza A, Paparelli C, Cavallaro G, Schillaci A, Cangemi V (2004) Palliative management of malignant antropyloric strictures: gastroenterostomy vs endoscopic stenting: a randomized prospective trial. Anticancer Res 24: 269–271
Johnsson E, Thune A, Liedman B (2004) Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World J Surg 28: 812–817
Maetani I, Tada T, Ukita T, Inoue H, Sakai Y, Nagao J (2004) Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 36: 73–78
Mittal A, Windsor J, Woodfield J, Casey P, Lane M (2004) Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 91: 205–209
Nassif T, Prat F, Meduri B, Fritsch J, Choury AD, Dumont JL, Auroux J, Desaint B, Boboc B, Ponsot P, Cervoni JP (2003) Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study. Endoscopy 35: 483–489
Rothlin MA, Schob O, Weber M (1999) Laparoscopic gastro- and hepaticojejunostomy for palliation of pancreatic cancer: a case controlled study. Surg Endosc 13: 1065–1069
Shone DN, Nikoomanesh P, Smith-Meek MM, Bender JS (1995) Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. Am J Gastroenterol 90: 1769–1770
Soetikno RM, Lichtenstein DR, Vandervoort J, Wong RC, Roston AD, Slivka A, Montes H, Carr-Eocke DE (1998) Palliation of malignant gastric outlet obstruction using an endoscopically placed Wallstent. Gastrointest Endosc 47: 267–270
Van der Schelling GP, Van den Bosch RP, Klinkenbij JH, Mulder PG, Jeekel J (1993) Is there a place for gastroenterostomy in patients with advanced cancer of the head of the pancreas? World J Surg 17: 128–132
Watanapa P, Williamson RC (1992) Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg 79: 8–20
Weaver DW, Wiencek RG, Bouwman DL, Walt AJ (1987) Gastrojejunostomy: is it helpful for patients with pancreatic cancer? Surgery 102: 608–613
Webb BM, Baron TH, Yacavone RF, Yates MR (2000) Endoscopic versus surgical palliation of malignant gastric outlet obstruction: a retrospective analysis (abstract). Gastrointest Endosc 51: AB221
Wong YT, Brams DM, Munson L, Sanders L, Heiss F, Chase M, Birkett DH (2002) Gastric outlet obstruction secondary to pancreatic cancer: surgical vs endoscopic palliation. SurgEndosc 16: 310–312
Yim HB, Jacobson BC, Saltzman JR, Johannes RS, Bounds BC, Lee JH, Shields SJ, Ruymann FW, Van Dam J, Carr-Eocke DE (2001) Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 53: 329–332
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Espinel, J., Sanz, Ó., Vivas, S. et al. Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation. Surg Endosc 20, 1083–1087 (2006). https://doi.org/10.1007/s00464-005-0354-8
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DOI: https://doi.org/10.1007/s00464-005-0354-8