Surgical Bypass Versus Endoscopic Stenting for Malignant Gastroduodenal Obstruction: a Decision Analysis

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2006 Dec 13

PMID 17160470

Citations 18

Authors

Ali Siddiqui

Stuart J Spechler

Sergio Huerta

Affiliations

Soon will be listed here.

Abstract

The treatment options for palliating malignant gastroduodenal obstruction include open gastrojejunostomy (OGJ), laparoscopic gastrojejunostomy (LGJ), and endoscopic stenting (ES). The aim of this study was to compare the clinical outcomes and costs among ES, OGJ, and LGJ in patients who present with gastroduodenal obstruction from advanced upper gastrointestinal tract cancer. We designed a model for patients with malignant gastroduodenal obstruction. We analyzed success rates, complication rates and costs of the three treatment modalities: ES, OGJ, and LGJ. Baseline outcomes and costs were based on published reports. Success was defined as no major procedure-related and long-term complications over a 1-month period. Failure of therapy was defined as recurrent symptoms or death due to a procedural complication. Sensitivity analyses and cost-effectiveness analyses for the various strategies were performed. ES resulted in the lowest mortality rate and the lowest cost of the three treatment options analyzed. Mortality in the OGJ group was 2.1 times that in the ES cohort and 1.8 times that in the LGJ cohort. Sensitivity analyses confirmed ES as the dominant strategy. In conclusion, ES is the preferred treatment for palliation of duodenal obstruction due to advanced upper gastrointestinal tract cancer.

Citing Articles

Gastrojejunostomy versus endoscopic stenting for the palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis.

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Endoscopic management of gastric outlet obstruction disease.

Tringali A, Giannetti A, Adler D Ann Gastroenterol. 2019; 32(4):330-337.

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Endoscopic Management of Combined Biliary and Duodenal Obstruction.

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Current role of palliative interventions in advanced pancreatic cancer.

Ciambella C, Beard R, Miner T World J Gastrointest Surg. 2018; 10(7):75-83.

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Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction.

Upchurch E, Ragusa M, Cirocchi R Cochrane Database Syst Rev. 2018; 5:CD012506.

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