Endoscopy or surgery for malignant GI outlet obstruction?

Area of Science:

• Gastroenterology
• Oncology
• Surgical Oncology

Background:

• Malignant gastroduodenal outflow obstruction (GOO) poses a significant treatment challenge.
• Open surgical gastrojejunostomy (GJ) has historically been the standard, but is associated with high morbidity and mortality.
• Endoscopic self-expanding metallic stent (SEMS) placement is an emerging alternative with promising preliminary results.

Purpose of the Study:

• To compare the technical and clinical success, morbidity, mortality, and hospital stay between endoscopic SEMS placement and open surgical GJ for GOO palliation.
• To evaluate the efficacy of SEMS as a less invasive treatment option for malignant GOO.

Main Methods:

• Retrospective review of 60 patients with GOO between April 1997 and November 2002.
• 47 patients with unresectable tumors underwent either SEMS placement (24 patients) or open surgical GJ (23 patients).
• 13 patients with extremely short life expectancy received nasogastric-jejunal tubes.

Main Results:

• Technical success rates were similar for SEMS and GJ.
• Clinical success was significantly higher for SEMS (92%) compared to GJ (56%).
• SEMS group showed shorter hospital stays (3.0 vs. 24.1 days), lower morbidity (17% vs. 61%), and reduced 30-day mortality (0% vs. 30%) compared to GJ.

Conclusions:

• SEMS insertion is superior to surgical GJ for palliation of GOO regarding clinical success, morbidity, and mortality.
• SEMS placement should be considered the first-line treatment for GOO relief.
• Further randomized, prospective studies comparing SEMS and laparoscopic GJ are warranted.