Gastrojejunostomy versus endoscopic duodenal stent placement for gastric outlet obstruction in patients with unresectable pancreatic cancer: a propensity score-matched analysis.

Abstract

BACKGROUND:

Treatments for patients with gastric outlet obstruction (GOO) due to unresectable pancreatic cancers (URPC) include gastrojejunostomy (GJJ) and endoscopic duodenal stent placement (EDSP). This study compared the efficacy and safety of GJJ and EDSP in patients with GOO due to URPC.

METHODS:

This study retrospectively evaluated consecutive patients with GOO due to URPC who underwent GJJ or EDSP between April 2016 and March 2020. The efficacy and safety of GJJ and EDSP were compared with propensity score analysis. Subgroup analyses of overall survival (OS) were compared after propensity matching.

RESULTS:

Data were obtained from 54 patients who underwent GJJ and from 73 who underwent EDSP at five tertiary care hospitals. After propensity matching, OS was significantly longer in patients who underwent GJJ than EDSP (110 vs. 63 days, respectively; p = 0.019). Evaluation of long-term adverse events showed that the frequency of cholangitis and obstructive jaundice was significantly lower in the matched GJJ than in the matched EDSP group (p = 0.012). Subgroup analyses showed that OS in patients with good performance status (PS; p = 0.041), biliary obstruction (p = 0.007), and duodenal obstruction near the papilla (p = 0.027), and those receiving chemotherapy (p = 0.010), was significantly longer in the matched GJJ group than in matched EDSP group.

CONCLUSION:

GJJ provides longer OS than EDSP for patients with GOO caused by URPC, especially for patients with good PS, biliary obstruction, and duodenal obstruction near the papilla, and those receiving chemotherapy.

• Authors: Takashi Tamura, Takenaka Mamoru, Taichi Terai, Takeshi Ogura, Masaji Tani, Toshio Shimokawa, Yuji Kitahata, Ippei Matsumoto, Akira Mitoro, Mitsuhiro Asakuma, Osamu Inatomi, Shunsuke Omoto, Masayuki Sho, Saori Ueno, Hiromitsu Maehira, Masayuki Kitano
• Journal: Surgical endoscopy (Surg Endosc) Vol. 37 Issue 3 Pg. 1890-1900 (03 2023) ISSN: 1432-2218 [Electronic] Germany
• PMID: 36258002 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Humans
• Treatment Outcome
• Propensity Score
• Retrospective Studies
• Gastric Bypass (adverse effects)
• Duodenal Obstruction
• Stomach Neoplasms
• Gastric Outlet Obstruction (etiology, surgery)
• Stents (adverse effects)
• Pancreatic Neoplasms (complications)
• Cholestasis
• Palliative Care