title: Gastroduodenal stents are associated with more durable patency as compared to percutaneous endoscopic gastrojejunostomy in the palliation of malignant gastric outlet obstruction.
abstract: Gastroduodenal outlet obstruction (GOO) is a critical complication of cancers localized within and adjacent to the upper gastrointestinal tract. Approaches to the relief of GOO include surgical bypass with gastrojejunostomy (GJ), endoluminal placement of a self-expandable metallic stent (SEMS), and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J). To date no studies have compared the outcome of utilizing PEG-J with other modalities of therapy.
  
  
  
  To determine if there is a difference in complications or effectiveness when survival and/or device patency of PEG-J is compared to that of gastroduodenal SEMS in patients with malignant GOO.
  
  
  
  Patients who underwent placement of either PEG-J or gastroduodenal SEMS for unresectable malignant GOO were included in a retrospective cohort study.
  
  
  
  24 patients (12 men) with a median age of 68.5 years underwent either PEG-J (n=12) or gastroduodenal SEMS (n=12) placement. Patients undergoing SEMS placement experienced longer overall device patency and/or survival as compared to those undergoing PEG-J (median 70 versus 35 days). Complications, including the need for re-intervention, were similar among both groups. Patients who underwent PEG-J as compared to those that had SEMS placement had a hazard ratio of 3.85 (CI 1.28-11.11) for decreased overall survival.
  
  
  
  In patients with malignant GOO, placement of a palliative SEMS for gastric decompression and nutrition was associated with longer aggregate device patency and survival as compared to PEG-J. Both modalities were similar with respect to complications and the need for re-intervention.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Strand
authors.forename: Ju-En C
authors.initials: JE
authors.lastname: Thlick
authors.forename: James T
authors.initials: JT
authors.lastname: Patrie
authors.forename: Monica R
authors.initials: MR
authors.lastname: Gaidhane
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Wang
keywords: PEG-J; duodenal obstruction; gastric outlet obstruction; percutaneous endoscopic gastrojejunostomy; stents