Surgical bypass versus endoscopic stenting for malignant gastroduodenal obstruction: A decision analysis

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45 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)276-281
Number of pages6
JournalDigestive Diseases and Sciences
Volume52
Issue number1
DOIs
StatePublished - Jan 2007

Keywords

  • Duodenal cancer
  • Duodenal obstruction
  • Gastric cancer
  • Gastric outlet obstruction
  • Laparoscopic gastrojejunostomy
  • Open gastrojejunostomy
  • Pancreatic cancer
  • Self-expanding metal stents

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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