title: Palliative gastrojejunostomy versus endoscopic stent placement for gastric outlet obstruction in patients with unresectable gastric cancer: a propensity score-matched analysis.
abstract: It remains unclear whether selection of treatment modality affects the survival of patients with malignant gastric outlet obstruction (GOO). We compared the effect of gastrojejunostomy (GJ) and endoscopic self-expandable metallic stent (SEMS) placement on the long-term outcomes of patients with malignant GOO caused by unresectable gastric cancer.
  
  
  
  We conducted a retrospective study of gastric cancer patients undergoing GJ or endoscopic SEMS placement for the palliation of malignant GOO. To reduce the effect of selection bias, we performed a propensity score-matching analysis between two groups.
  
  
  
  In a propensity-matched analysis (45 and 99 in GJ and SEMS groups, respectively), clinical success rates were comparable between the GJ and SEMS groups (95.6 and 96.0%), while the SEMS group showed significantly shorter hospital stays than the GJ group. The GJ group showed a significantly longer reintervention period and overall survival (393 and 129 days) compared to the SEMS group. In multivariate Cox regression analysis, GJ, low ECOG scale (good performance status), and additional chemo- or radiation therapy were identified as independent favorable predictors of overall survival. GJ was also identified as an independent protective predictor against reintervention.
  
  
  
  We found that palliative GJ was significantly associated with longer overall survival and lower risk of reintervention than SEMS placement in patients with malignant GOO caused by unresectable gastric cancer. Given very limited expected survival in selected patients with unresectable gastric cancer and more favorable short-term outcomes in cases of SEMS placement, individualized approach might be required in treatment decision between palliative GJ and SEMS placement.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
authors.forename: Seung Hyeon
authors.initials: SH
authors.lastname: Jang
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. leehyuk@skku.edu.
authors.forename: Hyuk
authors.identifier: 0000-0003-4271-7205
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. bhmin@skku.edu.
authors.forename: Byung-Hoon
authors.initials: BH
authors.lastname: Min
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Su Mi
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hye Seung
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada.
authors.forename: Keumhee C
authors.initials: KC
authors.lastname: Carriere
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
authors.forename: Yang Won
authors.initials: YW
authors.lastname: Min
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
authors.forename: Jun Haeng
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004724:Endoscopy; D005260:Female; D015390:Gastric Bypass; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Gastric outlet obstruction; Gastrojejunostomy; Self-expanding metallic stent