title: Survival and clinical outcome after endoscopic duodenal stent placement for malignant gastric outlet obstruction: comparison of pancreatic cancer and nonpancreatic cancer.
abstract: BACKGROUND
  Data on endoscopic stenting of malignant gastric outlet obstruction (GOO) are based on studies predominantly involving patients with pancreatic adenocarcinoma.
  
  
  OBJECTIVE
  To compare survival and clinical outcome after stent placement for GOO due to pancreatic cancer compared with nonpancreatic cancer.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Single tertiary hospital.
  
  
  METHODS
  A total of 292 patients with malignant GOO.
  
  
  METHODS
  Stent placement.
  
  
  METHODS
  Post-stent placement survival and clinical outcome.
  
  
  RESULTS
  In 196 patients with pancreatic cancer and 96 with nonpancreatic cancer, median post-stent placement survival was similar (2.7 months in pancreatic cancer vs 2.4 months in nonpancreatic cancer). Overall survival was shorter in patients with pancreatic cancer (13.7 vs 17.1 months; P = .004). Clinical success rates at 2 months (71% vs 91%) and reintervention rates (30% vs 23%) were comparable. Post-stent placement chemotherapy and the absence of distant metastasis were associated with better post-stent placement survival in both groups (pancreatic cancer: chemotherapy vs no chemotherapy, 5.4 vs 1.5 months, P < .0001; metastasis vs no metastasis, 1.8 vs 4.6, P = .005; nonpancreatic cancer: chemotherapy vs no chemotherapy, 9.2 vs 1.8, P = .001; metastasis vs no metastasis, 2.1 vs 6.1, P = .009).
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  In this large series of patients undergoing stent placement for malignant GOO in North America, we observed no difference in post-stent placement survival despite better overall survival in patients with nonpancreatic cancer. GOO is a marker for poor survival in malignancy, regardless of the type. Chemotherapy and the absence of distant metastasis were associated with better post-stent placement survival in both groups.
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Stephen Y
authors: SY
authors: Oh
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Alicia
authors: A
authors: Edwards
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Margaret
authors: M
authors: Mandelson
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Andrew
authors: A
authors: Ross
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Shayan
authors: S
authors: Irani
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Michael
authors: M
authors: Larsen
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Seng-Ian
authors: SI
authors: Gan
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Michael
authors: M
authors: Gluck
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Vincent
authors: V
authors: Picozzi
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Scott
authors: S
authors: Helton
authors: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors: Richard A
authors: RA
authors: Kozarek
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000601:surgery; D004379:Duodenal Neoplasms / Q000150:complications / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents