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vol.21 issue1Palliation of a malignant gastroduodenal obstruction author indexsubject indexarticles search
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Revista Colombiana de Gastroenterologia

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Abstract

CASTANO LLANO, Rodrigo et al. Comparison between a gastro-yeyunostomy and a metallic auto-expansible stent for palliation of a malignant gastro-duodenal obstruction. Rev Col Gastroenterol [online]. 2006, vol.21, n.1, pp.11-18. ISSN 0120-9957.

OBJECTIVE: Palliative treatment of malignant gastroduodenal obstruction has been made traditionally with gastrojejunostomy, palliation with autoexpandable metal prostheses is also effective and they improve the quality of life of the patients. We try to compare the effectiveness in the palliation of the malignant gastroduodenal obstruction between the conventional gastrojejunostomy and the application of an autoexpandable metal stent developed locally, evaluating the clinical success, morbidity, mortality and hospital stay. MATERIALS AND METHODS: Medical records of 70 patients with malignant gastroduodenal obstruction were revised, 35 patients were treated with the application of an autoexpandable metal stent and other 35 with gastrojejunostomy. Patients who underwent prophylactic gastrojejunostomy were excluded. RESULTS: In 35 patients (21 men) with obstructive tumours of the gastroduodenal tract was practiced gastrojejunostomy. In 34 of 35 patients (20 men) the gastroduodenal stent was placed (96%) without complications. The gastroduodenal obstruction was caused by gastric tumours, gallbladder o biliary tract cancer, metastases, pancreatic and ampular tumours. These entities were considered unresectables in all the patients. They were not differences among the origin of the obstruction, the clinical success in the relief of the same one, hospital mortality or survival. However, the time in that the feeding is resumed is shorter in the group of the stent (1,5 versus 8 days, p < 0,01). In terms of the hospital stay, from the realization of the procedure to the discharge home was longer for the patients with surgery (3 days versus 14 days, p>0,01) There wasn’t a significant difference in the activity index after endoscopic or surgical palliation. The mortality to 30 days was the same for both groups (5 in stent and 3 in gastrojejunostomy group) with more morbidity in the surgical group (36% versus 20%, p < 0,01) but with a similar survival for both procedures (98 days in gastrojejunostomy and 119 days in stent patients). CONCLUSIONS: The placement of autoexpandable metal stent was more beneficial in terms of hospital stay, time in oral resumption and morbidity that gastrojejunostomy for the palliation of malignant gastroduodenal obstruction.

Keywords : Malignant gastroduodenal obstruction; endoscopic interventional procedures; Stents and prostheses; Interventional endoscopy; Gastrojejunostomy.

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