Endoscopy 2018; 50(04): S32
DOI: 10.1055/s-0038-1637121
ESGE Days 2018 oral presentations
20.04.2018 – Digestive tract strictures: dilation, stenting
Georg Thieme Verlag KG Stuttgart · New York

STENTING VERSUS PALLIATIVE SURGERY FOR MALIGNANT GASTRODUODENAL AND JEJUNAL OBSTRUCTION

S Davydova
1   Peoples’ Friendship University of Russia, Institute of Medicine, Department of Faculty Surgery, Moscow, Russian Federation
,
A Fedorov
1   Peoples’ Friendship University of Russia, Institute of Medicine, Department of Faculty Surgery, Moscow, Russian Federation
,
A Klimov
1   Peoples’ Friendship University of Russia, Institute of Medicine, Department of Faculty Surgery, Moscow, Russian Federation
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Surgical formation of gastrojejunoanastomosis or jejunostoma and endoscopic self-expandable metal stent placement are two widely used palliative treatment methods for malignant gastroduodenal and jejunal obstruction, and a question of choice between them is still a controversial point. The aim of the study was to compare early and long-term outcomes of gastroenteral stenting versus traditional surgical palliation.

Methods:

95 patients were included in a non-randomized retrospective clinical trial at a university surgical center in Moscow at the period 1999 – 2015: 51 patients underwent endoscopic stenting, 44 – surgical intervention (41 gastrojejunoanastomoses and 3 jejunostomas). Level of stenosis caused by unresectable or metastatic predominantly gastric and pancreatic cancer: gastric outlet – 30 in stenting group/38 in surgical group, multi-level gastric obstruction – 3/3, duodenum – 11/3, jejunum (after gastrectomy) – 2/0, gastroduodenal or gastrojejunal anastomosis – 5/0. Adverse events, hospital stay and survival were analyzed.

Results:

There were no differences in technical and clinical success between two groups. More early major and minor complications were observed after surgical palliation (20,5%, 9 patients) as compared with stenting (7,8%, 4 patients), yet the difference was not significant (p = 0,0687, Fisher exact). Stenting was associated with lower postoperative in-hospital mortality (5,9% [3 patients] vs. 31,8% [14 patients], p = 0,0011) and shorter mean hospital stay (14 days vs. 23 days, p < 0,001, Mann-Whitney test). There was no significant difference in long-term results, neither in late complications (15% after stenting vs. 10% after surgery, p = 0,5709), nor in median survival (98 days vs. 88 days, p = 0,5208, Kaplan-Meier survival analysis).

Conclusions:

Gastroenteral stenting is associated with better short-term and similar long-term outcomes as compared with traditional surgical interventions, and therefore may be recommended as a final palliation for malignant gastroduodenal and jejunal obstruction.