Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction.
BACKGROUND
We prospectively compared laparoscopic gastrojejunostomy with duodenal stenting as a means of palliating malignant gastric outflow obstruction.


METHODS
A total of 27 patients with malignant gastric outflow obstruction were randomized to either laparoscopic gastrojejunostomy (LGJ) or duodenal stenting (DS) over a 3-year period.


RESULTS
Thirteen patients underwent successful LGJ and 10 had successful DS. Eight patients had complications after LGJ, but none had complications after DS. Patients who underwent LGJ had a significant increase in visual analog pain score at day 1 (p = 0.05), and also had a longer hospital stay compared to those who underwent DS (11.4 vs. 5.2 days, p = 0.02). After DS, patients experienced an improvement in physical health at 1 month as measured using the Short Form-36 (SF-36) questionnaire (p < 0.01). There was no change following LGJ.


CONCLUSIONS
Duodenal stenting is a safe means of palliating malignant gastric outflow obstruction. It offers significant advantages for patients compared with minimal-access surgery.
Mehta
S
S
Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, England, United Kingdom.
Hindmarsh
A
A
Cheong
E
E
Cockburn
J
J
Saada
J
J
Tighe
R
R
Lewis
M P N
MP
Rhodes
M
M
D000368:Aged; D004386:Duodenum; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology* / Q000628:therapy*; D005763:Gastroenterostomy / Q000009:adverse effects; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010149:Postoperative Pain / Q000503:physiopathology; D011446:Prospective Studies; D011788:Quality of Life; D015607:Stents / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016019:Survival Analysis