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Surgical Bypass Versus Endoscopic Stenting for Malignant Gastroduodenal Obstruction: A Decision Analysis

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Abstract

The treatment options for palliating malignant gastroduodenal obstruction include open gastrojejunostomy (OGJ), laparoscopic gastrojejunostomy (LGJ), and endoscopic stenting (ES). The aim of this study was to compare the clinical outcomes and costs among ES, OGJ, and LGJ in patients who present with gastroduodenal obstruction from advanced upper gastrointestinal tract cancer. We designed a model for patients with malignant gastroduodenal obstruction. We analyzed success rates, complication rates and costs of the three treatment modalities: ES, OGJ, and LGJ. Baseline outcomes and costs were based on published reports. Success was defined as no major procedure-related and long-term complications over a 1-month period. Failure of therapy was defined as recurrent symptoms or death due to a procedural complication. Sensitivity analyses and cost-effectiveness analyses for the various strategies were performed. ES resulted in the lowest mortality rate and the lowest cost of the three treatment options analyzed. Mortality in the OGJ group was 2.1 times that in the ES cohort and 1.8 times that in the LGJ cohort. Sensitivity analyses confirmed ES as the dominant strategy. In conclusion, ES is the preferred treatment for palliation of duodenal obstruction due to advanced upper gastrointestinal tract cancer.

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Authors and Affiliations

  1. Division of Gastroenterology, VA North Texas Health Care System and University of Texas Southwestern Medical School, Dallas, Texas, USA

    Ali Siddiqui & Stuart J. Spechler

  2. Division of GI/Endocrine Surgery, VA North Texas Health Care System and University of Texas Southwestern Medical School, Dallas, Texas, USA

    Sergio Huerta

  3. Division of Gastroenterology, VA North Texas Health Care System (111B1), 4500 South Lancaster, Dallas, Texas, 75216, USA

    Ali Siddiqui

Authors
  1. Ali Siddiqui
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  2. Stuart J. Spechler
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  3. Sergio Huerta
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Correspondence to Ali Siddiqui.

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This paper was completed without any support or sponsorship.

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Siddiqui, A., Spechler, S.J. & Huerta, S. Surgical Bypass Versus Endoscopic Stenting for Malignant Gastroduodenal Obstruction: A Decision Analysis. Dig Dis Sci 52, 276–281 (2007). https://doi.org/10.1007/s10620-006-9536-z

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  • DOI: https://doi.org/10.1007/s10620-006-9536-z

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