Author(s): Strand DS, Thlick JE, Patrie JT, Gaidhane MR, Kahaleh M,
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Abstract BACKGROUND: Gastroduodenal outlet obstruction (GOO) is a critical complication of cancers localized within and adjacent to the upper gastrointestinal tract. Approaches to the relief of GOO include surgical bypass with gastrojejunostomy (GJ), endoluminal placement of a self-expandable metallic stent (SEMS), and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J). To date no studies have compared the outcome of utilizing PEG-J with other modalities of therapy. OBJECTIVES: To determine if there is a difference in complications or effectiveness when survival and/or device patency of PEG-J is compared to that of gastroduodenal SEMS in patients with malignant GOO. METHODS: Patients who underwent placement of either PEG-J or gastroduodenal SEMS for unresectable malignant GOO were included in a retrospective cohort study. RESULTS: 24 patients (12 men) with a median age of 68.5 years underwent either PEG-J (n=12) or gastroduodenal SEMS (n=12) placement. Patients undergoing SEMS placement experienced longer overall device patency and/or survival as compared to those undergoing PEG-J (median 70 versus 35 days). Complications, including the need for re-intervention, were similar among both groups. Patients who underwent PEG-J as compared to those that had SEMS placement had a hazard ratio of 3.85 (CI 1.28-11.11) for decreased overall survival. CONCLUSION: In patients with malignant GOO, placement of a palliative SEMS for gastric decompression and nutrition was associated with longer aggregate device patency and survival as compared to PEG-J. Both modalities were similar with respect to complications and the need for re-intervention.
This article was published in J Interv Gastroenterol
and referenced in Journal of Gastrointestinal & Digestive System