title: Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction.
abstract: OBJECTIVE
  Endoscopic placement of enteral self-expandable metallic stents is an alternative to surgical gastrojejunostomy (GJ) for palliation of malignant gastric outlet obstruction (GOO). Factors associated with clinical outcomes are not known. The aims of this study are to compare the overall complication rate and effectiveness (duration of oral intake) between endoscopic stenting (ES) and GJ in patients with GOO and identify predictors of clinical outcomes.
  
  
  METHODS
  This was a retrospective cohort study at a single tertiary academic center. Patients who underwent ES or GJ for treatment of GOO between 1/2001 and 12/2010 were identified using an institutional claims database. The electronic medical records for each patient were reviewed. Univariate and multivariate logistic regression analyses were performed to study the association of treatment outcomes with patient factors and cancer therapy.
  
  
  RESULTS
  120 patients had ES while 227 had GJ. Technical success was higher for GJ (99 vs. 96 %, p = 0.004). Complication rates were higher in the GJ group (22.10 vs. 11.66 %, p = 0.02). Reintervention was more common with ES [adjusted odds ratio (OR) 9.18, p < 0.0001]. Mean length of hospital stay (LOHS) was shorter (adjusted p = 0.005) in the ES compared with the GJ group. However, mean hospital charges, including reinterventions, were greater in the ES group (US $34,250 vs. US $27,599, p = 0.03). ES and GJ had comparable reintervention-free time in patients who had reintervention (88 vs. 106 days, respectively, p = 0.79). Chemotherapy [adjusted hazard ratio (HR) 3 > 0.57, p = 0.04] and radiation therapy (adjusted HR 0.35, p = 0.03) were associated with significantly longer duration of oral intake after ES or GJ.
  
  
  CONCLUSIONS
  ES is associated with fewer complications, shorter LOHS, but higher reintervention rates and overall charges.
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 1830 E. Monument Street, Room 424, Baltimore, MD 21205, USA. mkhasha1@jhmi.edu
authors.forename: Mouen
authors.initials: M
authors.lastname: Khashab
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Alawad
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Shin
authors.forename: Katherine
authors.initials: K
authors.lastname: Kim
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bourdel
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.forename: Stuart
authors.initials: S
authors.lastname: Amateau
authors.forename: Patrick I
authors.initials: PI
authors.lastname: Okolo
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.forename: Christopher
authors.initials: C
authors.lastname: Wolfgang
authors.forename: Marcia Irene
authors.initials: MI
authors.lastname: Canto
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D017219:Gastric Outlet Obstruction / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult