Surgical Gastrojejunostomy or Endoscopic Stent Placement for the Palliation of Malignant Gastric Outlet Obstruction (SUSTENT Study): A Multicenter Randomized Trial

Gastrointest Endosc. 2010 Mar;71(3):490-9. doi: 10.1016/j.gie.2009.09.042. Epub 2009 Dec 8.

Abstract

Background: Both gastrojejunostomy (GJJ) and stent placement are commonly used palliative treatments of obstructive symptoms caused by malignant gastric outlet obstruction (GOO).

Objective: Compare GJJ and stent placement.

Design: Multicenter, randomized trial.

Setting: Twenty-one centers in The Netherlands.

Patients: Patients with GOO.

Interventions: GJJ and stent placement.

Main outcome measurements: Outcomes were medical effects, quality of life, and costs. Analysis was by intent to treat.

Results: Eighteen patients were randomized to GJJ and 21 to stent placement. Food intake improved more rapidly after stent placement than after GJJ (GOO Scoring System score > or = 2: median 5 vs 8 days, respectively; P < .01) but long-term relief was better after GJJ, with more patients living more days with a GOO Scoring System score of 2 or more than after stent placement (72 vs 50 days, respectively; P = .05). More major complications (stent: 6 in 4 patients vs GJJ: 0; P = .02), recurrent obstructive symptoms (stent: 8 in 5 patients vs GJJ: 1 in 1 patient; P = .02), and reinterventions (stent: 10 in 7 patients vs GJJ: 2 in 2 patients; P < .01) were observed after stent placement compared with GJJ. When stent obstruction was not regarded as a major complication, no differences in complications were found (P = .4). There were also no differences in median survival (stent: 56 days vs GJJ: 78 days) and quality of life. Mean total costs of GJJ were higher compared with stent placement ($16,535 vs $11,720, respectively; P = .049 [comparing medians]). Because of the small study population, only initial hospital costs would have been statistically significant if the Bonferroni correction for multiple testing had been applied.

Limitations: Relatively small patient population.

Conclusions: Despite slow initial symptom improvement, GJJ was associated with better long-term results and is therefore the treatment of choice in patients with a life expectancy of 2 months or longer. Because stent placement was associated with better short-term outcomes, this treatment is preferable for patients expected to live less than 2 months. (

Clinical trial registration number: ISRCTN 06702358.).

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Endoscopy, Gastrointestinal* / economics
  • Female
  • Gastric Bypass*
  • Gastric Outlet Obstruction / etiology
  • Gastric Outlet Obstruction / surgery*
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Pain Measurement
  • Palliative Care
  • Prosthesis Implantation / methods*
  • Quality of Life
  • Recurrence
  • Stents* / economics
  • Stomach Neoplasms / complications
  • Stomach Neoplasms / mortality
  • Treatment Outcome

Associated data

  • ISRCTN/ISRCTN06702358