Application of stent placement or nasojejunal feeding tube placement in patients with malignant gastric outlet obstruction: a retrospective series of 38 cases

Background: Malignant gastric outlet obstruction (MGOO), a late complication of advanced carcinoma of the stomach, duodenum, periampulla or pancreas, causes significant malnutrition and morbidity. The current treatment for MGOO is palliative in nature, with the goal of maintaining the best quality of life possible during the terminal phase of the illness.

Methods: A total of 38 patients with MGOO were enrolled in our institute from January 2007 to December 2011; 18 patients received nasojejunal (NJ) feeding tube placement, and 20 patients received duodenal stent placement. Food intake, measured by the gastric outlet obstruction scoring system (GOOSS), survival, complications, recurrent obstructive symptoms, and reintervention were evaluated in both groups.

Results: No significant differences were noted with regard to patient characteristics, survival rate (NJ group: 140 days vs. stent group: 186 days, p = 0.617), and complication rate. Recurrent obstructions developed more frequently in patients treated with NJ feeding tube placement than in those treated with duodenal stent placement [12 (66.7%) vs. 5 (25%), p = 0.014]. The duration for patency was shorter in the NJ group than in the stent group (median: 40 days vs. 130 days, p = 0.009). The GOOSS score was significantly better in the stent group than in the NJ group.

Conclusion: NJ tube placement and duodenal stent placement are both effective and safe treatments for patients with MGOO. Both groups had similar complication rates and survival rates. While NJ tube placement is associated with lower costs, stent placement has a longer duration of patency, superior oral intake, and a lower reintervention rate. We suggest that stent placement should be considered first in patients who are able to afford the related costs.