Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction

Mehta, Shaesta; Hindmarsh, Andrew; Cheong, Edward; Cockburn, J.F.; Saada, Janak; Tighe, R; Lewis, Michael P.; Rhodes, Michael

doi:10.1007/s00464-005-0130-9

Cited by 199 publications

(159 citation statements)

References 13 publications

(11 reference statements)

Supporting

Mentioning

146

Contrasting

Unclassified

Order By: Relevance

“…A randomized trial29 examining QoL in patients with unresectable periampullary tumours with or without prophylactic gastrojejunostomy reported a compliance rate of 90 per cent in the first 4 months of follow‐up, but it decreased to 75 per cent in the final 2 months of the study. Likewise, another randomized trial30 comparing stenting with surgical bypass for malignant gastric outlet obstruction reported a compliance rate of 57 per cent with follow‐up surveys at 1 month. Loss to follow‐up, owing to disease progression and the burden of questionnaire completion26, makes use of patient‐reported outcome measures challenging after palliative surgery, and loss of information from patients near the end life probably removes those with the worst QoL from analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic stent placement is associated with a shorter hospital stay, trend towards a lower periprocedural mortality rate, early resumption of oral intake and lower costs in patients with malignant gastric outlet obstruction compared with surgical treatment28 30, 33, 34, 35, 36, 37, at the expense of a greater need for reintervention owing to stent occlusion by food impaction, stent migration or tumour ingrowth27 33, 38.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Fujitani¹,

Ando

Sakamaki

et al. 2017

BJS Open

View full text Add to dashboard Cite

BackgroundQuality of life (QoL) is a key component in decision‐making for surgical palliation, but QoL data in association with surgical palliation in advanced gastric cancer are scarce. The aim of this multicentre observational study was to examine the impact of surgical palliation on QoL in advanced gastric cancer.MethodsThe study included patients with gastric outlet obstruction caused by incurable advanced primary gastric cancer who had no oral intake or liquid intake only. Patients underwent palliative distal/total gastrectomy or bypass surgery at the physician's discretion. The primary endpoint was change in QoL assessed at baseline, 14 days, 1 month and 3 months following surgical palliation by means of the EuroQoL Five Dimensions (EQ‐5D™) questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ‐STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications.ResultsSome 104 patients (23 distal gastrectomy, 9 total gastrectomy, 70 gastrojejunostomy, 2 exploratory laparotomy) were enrolled from 35 institutions. The mean EQ‐5D™ utility index scores remained consistent, with a baseline score of 0·74 and the change from baseline within ± 0·05. Gastric‐specific symptoms showed statistically significant improvement from baseline. The majority of patients were able to eat solid food 2 weeks after surgery and tolerated it thereafter. The rate of overall morbidity of grade III or more according to the Clavien–Dindo classification was 9·6 per cent (10 patients) and the 30‐day postoperative mortality rate was 1·9 per cent (2 patients).ConclusionIn patients with gastric outlet obstruction caused by advanced gastric cancer, surgical palliation maintained QoL while improving solid food intake, with acceptable morbidity for at least the first 3 months after surgery. Registration number 000023494 (UMIN Clinical Trials Registry).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Fujitani¹,

Ando

Sakamaki

et al. 2017

BJS Open

View full text Add to dashboard Cite

show abstract

“…In addition, results of small randomized trials concluded that stent placement was superior to gastrojejunostomy [7,8]. Stent placement in patients with a malignant obstruction at the level of the distal stomach or proximal duodenum (superior, descending and first half of the horizontal part) is routinely performed with a therapeutic gastroscope.…”

Section: Introductionmentioning

confidence: 99%

Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

et al. 2008

View full text Add to dashboard Cite

Background Stent placement in the distal duodenum or proximal jejunum with a therapeutic gastroscope can be difficult, because of the reach of the endoscope, loop formation in the stomach, and flexibility of the gastroscope. The use of a colonoscope may overcome these problems. Objective To report our experience with distal duodenal stent placement in 16 patients using a colonoscope. Methods Multicenter, retrospective series of patients with a malignant obstruction at the level of the distal duodenum and proximal jejunum and treated by stent placement using a colonoscope. Main outcome measurements are technical success, ability to eat, complications, and survival. Results Stent placement was technically feasible in 93% (15/16) of patients. Food intake improved from a median gastric outlet obstruction scoring system (GOOSS) score of 1 (no oral intake) to 3 (soft solids) (p = 0.001). Severe complications were not observed. One patient had persistent obstructive symptoms presumably due to motility problems.Recurrent obstructive symptoms were caused by tissue/ tumor ingrowth through the stent mesh [n = 6 (38%)] and stent occlusion by debris [n = 1 (6%)]. Reinterventions included additional stent placement [n = 5 (31%)], gastrojejunostomy [n = 2 (12%)], and endoscopic stent cleansing [n = 1 (6%)]. Median survival was 153 days. Conclusion Duodenal stent placement can effectively and safely be performed using a colonoscope in patients with an obstruction at the level of the distal duodenum or proximal jejunum. A colonoscope has the advantage that it is long enough and offers good endoscopic stiffness, which avoids looping in the stomach.

show abstract

“…[42][43][44][45] The Karnofsky scale, however, captures only one aspect of quality of life (physical function) and is presently considered inadequate for evaluation of overall quality of life. 8 One randomized study using SF-36 Physical Health scores, a sensitive indicator of quality of life, 46 found that these scores were significantly higher 1 month after stent placement than after laparoscopic bypass in the palliative treatment of malignant GOO. 46 That study, however, included small numbers of patients (10 per group).…”

Section: Quality Of Lifementioning

confidence: 99%

Malignant Gastric Outlet Obstructions: Treatment with Self-Expandable Metallic Stents

2010

View full text Add to dashboard Cite

Unresectable malignant gastric outlet obstruction (GOO) severely affects the quality of life, with complications that include nausea, vomiting, aspiration, pain, and malnutrition. Although palliative surgical procedures have been traditionally performed, they are associated with high morbidity and mortality rates. Placing self-expandable metallic stents is associated with higher clinical success rates, lower morbidity, shorter time from the procedure to starting oral intake, lower incidence of delayed gastric emptying, and a shorter hospital stay than palliative surgery. Fluoroscopic or endoscopic placement of either bare or covered selfexpandable metallic stents is a safe, nonsurgical, palliative treatment option for unresectable malignant GOOs, with a high clinical success rate and a low rate of serious complications. Stent obstruction and migration are the most common complications, but most can be managed by interventional treatments. Although there have been substantial developments in stent design over the past decade, large prospective, randomized studies are required to determine the ideal stent for malignant GOOs. (Gut Liver 2010; 4(Suppl. 1):S32-38)

show abstract

Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction

Abstract: Duodenal stenting is a safe means of palliating malignant gastric outflow obstruction. It offers significant advantages for patients compared with minimal-access surgery.

Cited by 199 publications

References 13 publications

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

Malignant Gastric Outlet Obstructions: Treatment with Self-Expandable Metallic Stents

Contact Info

Product

Resources

About