title: Gastric outlet obstruction in gastric cancer: a comparison of three palliative methods.
abstract: BACKGROUND
  Gastric outlet obstruction (GOO) commonly occurs in advanced gastric cancer. Our aim was to evaluate the results of endoscopic stenting (ES), palliative resection (PR), and gastrojejunostomy (GJ) as palliation of GOO.
  
  
  METHODS
  A total of 97 patients (50 ES, 26 PR, 21 GJ) were included in this retrospective study. All the patients had primary gastric cancer and symptoms of GOO.
  
  
  RESULTS
  Compared to surgery, ES resulted in a faster improvement on oral intake and symptom relief (P < 0.001) and a shorter hospitalization (P < 0.001). Complication rates, hospital re-admissions, occurrence of biliary obstruction, and the number of patients receiving chemotherapy were similar. The median symptom-free and overall survival were longest in the PR group (P < 0.001). In multivariate survival analysis, independent prognostic factors were age, BMI, pre-procedure GOOSS, palliative resection as treatment modality, and chemotherapy.
  
  
  CONCLUSIONS
  In gastric cancer and GOO, the clinical condition of the patient before treatment affects survival and should be taken into account in determining the treatment. PR seems to provide a survival benefit and should be considered as treatment option for patients suitable for surgery. For patients unfit for surgery, ES provides rapid and efficient palliation. Chemotherapy also seems to improve survival in gastric cancer and GOO.
authors.affiliation: Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, HUS, Finland.
authors.forename: Ilona
authors.initials: I
authors.lastname: Keränen
authors.forename: Leena
authors.initials: L
authors.lastname: Kylänpää
authors.forename: Marianne
authors.initials: M
authors.lastname: Udd
authors.forename: Johanna
authors.initials: J
authors.lastname: Louhimo
authors.forename: Anna
authors.initials: A
authors.lastname: Lepistö
authors.forename: Jorma
authors.initials: J
authors.lastname: Halttunen
authors.forename: Arto
authors.initials: A
authors.lastname: Kokkola
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010359:Patient Readmission; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: gastric carcinoma; stent; surgical therapy