TY - JOUR
T1 - Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial
AU - Jeurnink, Suzanne M.
AU - Steyerberg, Ewout W.
AU - van Hooft, Jeanin E.
AU - van Eijck, Casper H. J.
AU - Schwartz, Matthijs P.
AU - Vleggaar, Frank P.
AU - Kuipers, Ernst J.
AU - Siersema, Peter D.
AU - AUTHOR GROUP
AU - Jeurnink, S. M.
AU - Kuipers, E. J.
AU - Siersema, P. D.
AU - Steyerberg, E. W.
AU - Polinder, S.
AU - Borsboom, G.
AU - van Eijck, C. H. J.
AU - Fockens, P.
AU - Gouma, D. J.
AU - Schwartz, M. P.
AU - Vermeijden, J. R.
AU - van Ooijen, B.
AU - Vleggaar, F. P.
AU - Borel Rinkes, I. H. M.
AU - Grubben, M.
AU - van Laarhoven, C. H. J. M.
AU - Peters, F. T. M.
AU - Porte, R. J.
AU - Plukker, J. Th M.
AU - van Spreeuwel, J. P.
AU - Jakimowicz, J. J.
AU - Boot, H.
AU - Cats, A.
AU - van Coevorden, F. V.
AU - Klaase, J. M.
AU - van der Waaij, L. A.
AU - Baas, P.
AU - van der Schaar, P.
AU - Sosef, M. N.
AU - Timmer, R.
AU - van Ramshorts, B.
AU - Nicolai, J. J.
AU - Houben, M. H. M. G.
AU - Steup, W. H.
AU - Pahlplatz, P. V. M.
AU - Brouwers, M. A. M.
AU - Meijssen, M. A. C.
AU - Marinelli, A.
AU - van der Linde, K.
AU - Manusama, E.
AU - ter Borg, F.
AU - Lesterhuis, W.
PY - 2010
Y1 - 2010
N2 - BACKGROUND: Both gastrojejunostomy (GJJ) and stent placement are commonly used palliative treatments of obstructive symptoms caused by malignant gastric outlet obstruction (GOO). OBJECTIVE: Compare GJJ and stent placement. DESIGN: Multicenter, randomized trial. SETTING: Twenty-one centers in The Netherlands. PATIENTS: Patients with GOO. INTERVENTIONS: GJJ and stent placement. MAIN OUTCOME MEASUREMENTS: Outcomes were medical effects, quality of life, and costs. Analysis was by intent to treat. RESULTS: Eighteen patients were randomized to GJJ and 21 to stent placement. Food intake improved more rapidly after stent placement than after GJJ (GOO Scoring System score > or = 2: median 5 vs 8 days, respectively; P < .01) but long-term relief was better after GJJ, with more patients living more days with a GOO Scoring System score of 2 or more than after stent placement (72 vs 50 days, respectively; P = .05). More major complications (stent: 6 in 4 patients vs GJJ: 0; P = .02), recurrent obstructive symptoms (stent: 8 in 5 patients vs GJJ: 1 in 1 patient; P = .02), and reinterventions (stent: 10 in 7 patients vs GJJ: 2 in 2 patients; P < .01) were observed after stent placement compared with GJJ. When stent obstruction was not regarded as a major complication, no differences in complications were found (P = .4). There were also no differences in median survival (stent: 56 days vs GJJ: 78 days) and quality of life. Mean total costs of GJJ were higher compared with stent placement ($16,535 vs $11,720, respectively; P = .049 [comparing medians]). Because of the small study population, only initial hospital costs would have been statistically significant if the Bonferroni correction for multiple testing had been applied. LIMITATIONS: Relatively small patient population. CONCLUSIONS: Despite slow initial symptom improvement, GJJ was associated with better long-term results and is therefore the treatment of choice in patients with a life expectancy of 2 months or longer. Because stent placement was associated with better short-term outcomes, this treatment is preferable for patients expected to live less than 2 months. (Clinical trial registration number: ISRCTN 06702358.)
AB - BACKGROUND: Both gastrojejunostomy (GJJ) and stent placement are commonly used palliative treatments of obstructive symptoms caused by malignant gastric outlet obstruction (GOO). OBJECTIVE: Compare GJJ and stent placement. DESIGN: Multicenter, randomized trial. SETTING: Twenty-one centers in The Netherlands. PATIENTS: Patients with GOO. INTERVENTIONS: GJJ and stent placement. MAIN OUTCOME MEASUREMENTS: Outcomes were medical effects, quality of life, and costs. Analysis was by intent to treat. RESULTS: Eighteen patients were randomized to GJJ and 21 to stent placement. Food intake improved more rapidly after stent placement than after GJJ (GOO Scoring System score > or = 2: median 5 vs 8 days, respectively; P < .01) but long-term relief was better after GJJ, with more patients living more days with a GOO Scoring System score of 2 or more than after stent placement (72 vs 50 days, respectively; P = .05). More major complications (stent: 6 in 4 patients vs GJJ: 0; P = .02), recurrent obstructive symptoms (stent: 8 in 5 patients vs GJJ: 1 in 1 patient; P = .02), and reinterventions (stent: 10 in 7 patients vs GJJ: 2 in 2 patients; P < .01) were observed after stent placement compared with GJJ. When stent obstruction was not regarded as a major complication, no differences in complications were found (P = .4). There were also no differences in median survival (stent: 56 days vs GJJ: 78 days) and quality of life. Mean total costs of GJJ were higher compared with stent placement ($16,535 vs $11,720, respectively; P = .049 [comparing medians]). Because of the small study population, only initial hospital costs would have been statistically significant if the Bonferroni correction for multiple testing had been applied. LIMITATIONS: Relatively small patient population. CONCLUSIONS: Despite slow initial symptom improvement, GJJ was associated with better long-term results and is therefore the treatment of choice in patients with a life expectancy of 2 months or longer. Because stent placement was associated with better short-term outcomes, this treatment is preferable for patients expected to live less than 2 months. (Clinical trial registration number: ISRCTN 06702358.)
U2 - https://doi.org/10.1016/j.gie.2009.09.042
DO - https://doi.org/10.1016/j.gie.2009.09.042
M3 - Article
C2 - 20003966
SN - 0016-5107
VL - 71
SP - 490
EP - 499
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 3
ER -