Endoscopic duodenal stent versus surgical gastrojejunostomy for gastric outlet obstruction in patients with advanced pancreatic cancer

Shinya Uemura; Takuji Iwashita; Keisuke Iwata; Tsuyoshi Mukai; Shinji Osada; Takafumi Sekino; Takahito Adachi; Masahiko Kawai; Ichiro Yasuda; Masahito Shimizu

doi:10.1016/j.pan.2018.04.015

Endoscopic duodenal stent versus surgical gastrojejunostomy for gastric outlet obstruction in patients with advanced pancreatic cancer

Pancreatology. 2018 Jul;18(5):601-607. doi: 10.1016/j.pan.2018.04.015. Epub 2018 May 3.

Authors

Affiliations

¹ First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
² First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan. Electronic address: takuji-guh@umin.ac.jp.
³ Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.
⁴ Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
⁵ Multidisciplinary Therapy for Hepato-Biliary-Pancreatic Cancer, Gifu University School of Medicine, Gifu, Japan.
⁶ Department of General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
⁷ Department of Surgery, Gifu Municipal Hospital, Gifu, Japan.
⁸ Department of Surgery, Gifu Prefectural General Medical Center, Gifu, Japan.
⁹ Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan.

PMID: 29753623
DOI: 10.1016/j.pan.2018.04.015

Abstract

Background: Malignant gastric outlet obstruction (GOO) often develops in patients with advanced pancreatic cancer (APC). It is not clear whether endoscopic duodenal stenting (DS) or surgical gastrojejunostomy (GJJ) is preferable as palliative treatment.

Aims: To compare the efficacy and safety of GJJ and DS for GOO with APC.

Methods: Consecutive 99 patients who underwent DS or GJJ for GOO with APC were evaluated. We compared the technical and clinical success rates, the incidence of adverse event (AE), the time to start chemotherapy and discharge and survival durations between DS and GJJ. Prognostic factors for overall survival (OS) were investigated on the multivariate analysis.

Results: GOO was managed with GJJ in 35 and DS in 64. The technical and clinical success rates were comparable. DS was associated with shorter time to start oral intake and earlier chemotherapy start and discharge. No difference was seen in the early and late AE rates. Multivariate analyses of prognostic factors for OS showed that performance status ≧2, administration of chemotherapy, and presence of obstructive jaundice to be significant factors. There were no significant differences in survival durations between the groups, regardless of the PS.

Conclusions: There were no significant differences in the technical and clinical success and AE rates and survival duration between DS and GJJ in management of GOO by APC. DS may be a preferable option over GJJ given that it will lead to an earlier return to oral intake, a shortened length of hospital stay, and finally an earlier referral for chemotherapy.

Keywords: Biliary drainage; Duodenal stent; Gastric outlet obstruction; Gastrojejunostomy; Palliative treatment.