title: Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery.
abstract: BACKGROUND
  In patients with gastric outlet obstruction (GOO) caused by gastric cancer, choosing between self-expandable metal stent (SEMS) placement and gastrojejunostomy (GJJ) is of concern, especially in those with good performance status.
  
  
  OBJECTIVE
  To compare SEMS placement and GJJ.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Single tertiary referral center.
  
  
  METHODS
  Patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 who had GOO caused by unresectable gastric cancer.
  
  
  METHODS
  SEMS placement and GJJ.
  
  
  METHODS
  Success rate, adverse events, patency, and survival duration.
  
  
  RESULTS
  Of the 113 patients in this study, 72 underwent SEMS placement and 41 underwent GJJ. The 2 groups did not differ in the technical and clinical success and incidence of early adverse events. However, the rate of late adverse events was significantly higher in the SEMS group (44.4% vs 12.2%; P < .001). The median patency duration was shorter after SEMS placement than after GJJ (125 days vs 282 days; P = .001), even after additional SEMS placement (210 days vs 282 days; P = .044). The median survival was also significantly shorter after SEMS placement than after GJJ (189 days vs 293 days; P = .003). Survival differed between treatments in patients with ECOG 0-1 (P = .006) but not in those with an ECOG performance status of 2 (P = .208).
  
  
  CONCLUSIONS
  Retrospective and single-center study.
  
  
  CONCLUSIONS
  GJJ is preferable to SEMS placement for the palliation of GOO caused by unresectable or metastatic gastric cancer in patients with a good performance status, especially ECOG 0-1.
authors.affiliation: Seoul St. Mary's Hospital, Gastrointestinal Center, Department of Internal Medicine, Medical College, Catholic University of Korea, Seoul, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: No
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Chul-Hyun
authors.initials: CH
authors.lastname: Lim
authors.forename: Jin Su
authors.initials: JS
authors.lastname: Kim
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.forename: In Seok
authors.initials: IS
authors.lastname: Lee
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
authors.forename: Kyu Yong
authors.initials: KY
authors.lastname: Choi
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D017741:Survivors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome