title: Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies.
abstract: OBJECTIVE
  Palliative treatment for duodenal stenosis with an enteral stent is effective in enhancing the quality of life of patients with duodenal obstruction. There have been no thorough comparisons of duodenal stent placement with standard surgical gastrojejunostomy. The present study evaluated the outcome of duodenal stent placement and surgical gastrojejunostomy for palliation of duodenal stenosis caused by pancreaticobiliary malignancies.
  
  
  METHODS
  Medical records for patients who underwent palliative enteral stenting during the past 9 years were retrospectively reviewed, and the patients' clinical outcome was compared with that in patients who underwent open surgical gastrojejunostomy during the same period. Patients who underwent prophylactic gastrojejunostomy were excluded from the study.
  
  
  RESULTS
  Twenty patients (11 men, nine women; mean age 71.8 years) with pancreaticobiliary malignancy underwent palliative enteral stenting (stent group). Nineteen patients (12 men, seven women; mean age 68.7 years) with pancreaticobiliary malignancies underwent surgical gastrojejunostomy (bypass group). In the stent group, the diagnoses were 12 pancreatic cancers, six gallbladder cancers, one bile duct cancer, and one ampullary cancer. In the bypass group, the diagnoses were 14 pancreatic cancers and five gallbladder cancers. There were no significant differences between the two groups with regard to clinical background. Both procedures were successful. There were no differences between the two groups with regard to the technical or clinical success rates, patient survival, possibility of discharge, need for parenteral nutrition, or incidence of complications. However, the time from the procedure to resumption of food intake was shorter in the stent group than in the bypass group (1 day vs. 9 days; P < 0.0001). Improvement in the performance score after the procedure was observed more frequently in the stent group (65 % vs. 26.3 %; P < 0.05). In terms of the median hospital stay from the time of the procedure to the time of initial discharge home (12 patients vs. nine patients), there was no statistical difference (15 days vs. 30 days) due to the small size of the sample. There was no procedure-related mortality in either group.
  
  
  CONCLUSIONS
  Palliative stent placement was more beneficial than surgical gastrojejunostomy in enhancing the quality of life of patients with duodenal obstruction due to pancreaticobiliary malignancies.
authors.affiliation: Third Dept. of Internal Medicine, Toho University, Tokyo, Japan. maet@oha.toho-u.ac.jp
authors.forename: I
authors.initials: I
authors.lastname: Maetani
authors.forename: T
authors.initials: T
authors.lastname: Tada
authors.forename: T
authors.initials: T
authors.lastname: Ukita
authors.forename: H
authors.initials: H
authors.lastname: Inoue
authors.forename: Y
authors.initials: Y
authors.lastname: Sakai
authors.forename: J
authors.initials: J
authors.lastname: Nagao
mesh_terms: D000368:Aged; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007582:Jejunostomy; D008297:Male; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D011859:Radiography; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome