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DOI: 10.1055/s-2004-814123
Comparison of Duodenal Stent Placement with Surgical Gastrojejunostomy for Palliation in Patients with Duodenal Obstructions Caused by Pancreaticobiliary Malignancies
Publication History
Submitted 31 January 2003
Accepted after Revision 22 June 2003
Publication Date:
14 January 2004 (online)

Background and Study Aims: Palliative treatment for duodenal stenosis with an enteral stent is effective in
enhancing the quality of life of patients with duodenal obstruction. There have been
no thorough comparisons of duodenal stent placement with standard surgical gastrojejunostomy.
The present study evaluated the outcome of duodenal stent placement and surgical gastrojejunostomy
for palliation of duodenal stenosis caused by pancreaticobiliary malignancies.
Patients and Methods: Medical records for patients who underwent palliative enteral stenting during the
past 9 years were retrospectively reviewed, and the patients’ clinical outcome was
compared with that in patients who underwent open surgical gastrojejunostomy during
the same period. Patients who underwent prophylactic gastrojejunostomy were excluded
from the study.
Results: Twenty patients (11 men, nine women; mean age 71.8 years) with pancreaticobiliary
malignancy underwent palliative enteral stenting (stent group). Nineteen patients
(12 men, seven women; mean age 68.7 years) with pancreaticobiliary malignancies underwent
surgical gastrojejunostomy (bypass group). In the stent group, the diagnoses were
12 pancreatic cancers, six gallbladder cancers, one bile duct cancer, and one ampullary
cancer. In the bypass group, the diagnoses were 14 pancreatic cancers and five gallbladder
cancers. There were no significant differences between the two groups with regard
to clinical background. Both procedures were successful. There were no differences
between the two groups with regard to the technical or clinical success rates, patient
survival, possibility of discharge, need for parenteral nutrition, or incidence of
complications. However, the time from the procedure to resumption of food intake was
shorter in the stent group than in the bypass group (1 day vs. 9 days; P < 0.0001). Improvement in the performance score after the procedure was observed
more frequently in the stent group (65 % vs. 26.3 %; P < 0.05). In terms of the median hospital stay from the time of the procedure to the
time of initial discharge home (12 patients vs. nine patients), there was no statistical
difference (15 days vs. 30 days) due to the small size of the sample. There was no
procedure-related mortality in either group.
Conclusions: Palliative stent placement was more beneficial than surgical gastrojejunostomy in
enhancing the quality of life of patients with duodenal obstruction due to pancreaticobiliary
malignancies.
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I. Maetani, M. D.
Third Dept. of Internal Medicine · Toho University Ohashi Hospital
2-17-6 Ohashi Meguro-ku · Tokyo 153-8515 · Japan
Fax: + 81-3-3468-1269
Email: maet@oha.toho-u.ac.jp