***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Gastrojejunostomy ( GJJ ) and stent placement are the most commonly used palliative treatments for malignant gastric outlet obstruction ( GOO ) . In a recent r and omized trial , stent placement was preferred in patients with a relatively short survival and GJJ in patients with a longer survival . As health economic aspects have only been studied in general terms , we estimated the cost of GJJ and that of stent placement in such patients . Methods In the SUSTENT study , patients were r and omized to GJJ ( n = 18 ) or stent placement ( n = 21 ) . Pancreatic cancer was the most common cause of GOO . We compared initial costs and costs during follow-up . For cost-effectiveness , the incremental cost-effectiveness ratio was calculated . Results Food intake improved more rapidly after stent placement than after GJJ , but long-term relief of obstructive symptoms was better after GJJ . More major complications ( P = 0.02 ) occurred and more re interventions were performed ( P < 0.01 ) after stent placement than after GJJ  . Initial costs were higher for GJJ compared to stent placement ( € 8315 vs. € 4820 , P < 0.001 ) . We found no difference in follow-up costs . Total costs per patient were higher for GJJ compared to stent placement ( € 12433 vs. € 8819 , P = 0.049 ) . The incremental cost-effectiveness ratio  of GJJ compared to stent placement was € 164 per extra day with a gastric outlet obstruction scoring system ( GOOSS ) ≥2 adjusted for survival . Conclusions Medical effects were better after GJJ , although GJJ had higher total costs . Since the cost difference between the two treatments was only small , cost should not play a predominant role when deciding on the type of treatment assigned to patients with malignant GOO ( IS RCT N 06702358 ) Background Gastric outlet obstruction poses diagnostic and therapeutic challenges to general surgeons practicing in re source -limited countries . There is a paucity of published data on this subject in our setting . This study was undertaken to highlight the etiological spectrum and treatment outcome of gastric outlet obstruction in our setting and to identify prognostic factors for morbidity and mortality . Methods This was a descriptive prospect i ve study which was conducted at Bug and o Medical Centre between March 2009 and February 2013 . All patients with a clinical diagnosis of gastric outlet obstruction were , after informed consent for the study , consecutively enrolled into the study . Statistical data analysis was done using SPSS computer software version 17.0 . Results A total of 184 patients were studied . More than two-third of patients were males . Patients with malignant gastric outlet obstruction were older than those of benign type . This difference was statistically significant ( p < 0.001 ) . Gastric cancer was the commonest malignant cause of gastric outlet obstruction where as peptic ulcer disease was the commonest benign cause . In children , the commonest cause of gastric outlet obstruction was congenital pyloric stenosis ( 13.0 % ) . Non-bilious vomiting ( 100 % ) and weight loss ( 93.5 % ) were the most frequent symptoms . Eighteen ( 9.8 % ) patients were HIV positive with the median CD 4 + count of 282 cells/μl . A total of 168 ( 91.3 % ) patients underwent surgery . Of these , gastro-jejunostomy ( 61.9 % ) was the most common surgical procedure performed . The complication rate was 32.1 % mainly surgical site infections ( 38.2 % ) . The median hospital stay and mortality rate were 14 days and 18.5 % respectively . The presence of postoperative complication was the main predictor of hospital stay ( p = 0.002 ) , whereas the age > 60 years , co-existing medical illness , malignant cause , HIV positivity , low CD 4 count ( < 200 cells/μl ) , high ASA class and presence of surgical site infection significantly predicted mortality ( p < 0.001 ) . The follow up of patients was generally poor as more than 60 % of patients were lost to follow up . Conclusion Gastric outlet obstruction in our setting is more prevalent in males and the cause is mostly malignant . The majority of patients present late with poor general condition . Early recognition of the diagnosis , aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with gastric outlet obstruction are to be avoided Background We prospect ively compared laparoscopic gastrojejunostomy with duodenal stenting as a means of palliating malignant gastric outflow obstruction . Methods A total of 27 patients with malignant gastric outflow obstruction were r and omized to either laparoscopic gastrojejunostomy ( LGJ ) or duodenal stenting ( DS ) over a 3-year period . Results Thirteen patients underwent successful LGJ and 10 had successful DS . Eight patients had complications after LGJ , but none had complications after DS . Patients who underwent LGJ had a significant increase in visual analog pain score at day 1 ( p = 0.05 ) , and also had a longer hospital stay compared to those who underwent DS ( 11.4 vs. 5.2 days , p = 0.02 ) . After DS , patients experienced an improvement in physical health at 1 month as measured using the Short Form-36 ( SF-36 ) question naire ( p < 0.01 ) . There was no change following LGJ . Conclusion Duodenal stenting is a safe means of palliating malignant gastric outflow obstruction . It offers significant advantages for patients compared with minimal-access surgery 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 , r and omized trial . SETTING Twenty-one centers in The Netherl and s. 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 r and omized 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 re interventions ( 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 IS RCT N 06702358 . ) BACKGROUND Gastroenterostomy was the palliative treatment of choice in patients with malignant unresectable gastric outlet obstruction .  Palliative endoscopic treatment of malignant gastric outlet obstruction with endoluminal self-exp and ing metallic stents is nowadays a well-established procedure . PATIENTS AND METHODS Eighteen patients referred for treatment with diagnosis of malignant strictures of the antro-pyloric tract presenting at an advanced unresectable stage . The patients were r and omly assigned into two treatment groups ( endoscopic vs. surgery ) according to r and om-number tables . The length of procedure , morbidity and mortality rate , restoration of oral intake and gastric emptying at 8 , 15 days and 3 months from treatment and hospital stay were assessed . RESULTS Endoscopic group : The median length of procedure was 40 minutes . No death and one minor complication ( 11.1 % ) was reported . Mean time for oral intake was 2.1 days . Gastric emptying was satisfactory in 88.9 % after 8 days and in 100 % of patients after 15 days and 3 months . The median hospital stay was 3.1 days . Surgery group : The median length of the operation was 93 minutes . No mortality was reported . One patient ( 11.1 % ) developed anastomotic bleeding which required relaparotomy . Mean time for oral intake was 6.3 days . Gastric emptying was satisfactory in 66.7 % of patients after 8 days , in 88.9 % after 15 days and in 100 % after 3 months . The median hospital stay was 10 days . CONCLUSION There were no statistically significant differences between the 2 groups even with respect to morbidity , mortality , delayed gastric emptying and clinical outcomes at 3-month follow-up . Endoscopic stenting was significantly more effective with respect to operative time , restoration of oral intake and median hospitalization . Our results would suggest that endoscopically placed metal stents offer an effective alternative to surgical palliation in patients with unresectable malignant strictures BACKGROUND Gastrojejunostomy and stentplacement are the most commonly used treatments for malignant gastric outlet obstruction ( GOO ) . The preference for either treatment largely depends on the expected survival . Our objective was to investigate predictors of survival in patients with malignant GOO and to develop a model that could aid in the decision for either gastrojejunostomy or stentplacement . METHODS Prognostic factors for survival were collected from a literature search and evaluated in our patient population , which included 95 retrospectively and 56 prospect ively followed cases . All 151 patients were treated with gastrojejunostomy or stentplacement . RESULTS A higher WHO performance score was the only significant prognostic factor for survival in our multivariable analysis ( HR 2.2 95%CI 1.7 - 2.9 ) , whereas treatment for obstructive jaundice , gender , age , metastases , weight loss , level of obstruction and pancreatic cancer were not . A prognostic model that includes the WHO score was able to distinguish patients with a poor survival ( WHO score 3 - 4 , median survival : 31 days ) from those with a relatively intermediate or good survival ( WHO score 2 , median survival : 69 and WHO score 0 - 1 , median survival : 139 days , respectively ) . CONCLUSIONS Only the WHO score is a significant predictor of survival in patients with malignant GOO . A simple prognostic model is able to guide the palliative treatment decision for either gastrojejunostomy ( WHO score 0 - 1 ) or stentplacement ( WHO 3 - 4 ) in patients with malignant GOO BACKGROUND Malignant gastric outlet obstruction is often treated by stent placement . OBJECTIVE To investigate the outcomes of stent placement in the palliative treatment of malignant neoplasms . DESIGN Prospect i ve , observational , multicenter registry . SETTING Six tertiary care centers in 5 countries . PATIENTS A total of 108 adult patients with malignant gastric outlet obstruction . INTERVENTIONS Placement of an uncovered , self-exp and able , metal duodenal stent . MAIN OUTCOME MEASUREMENTS The primary endpoint was stent patency at 14 days after stent implantation . Secondary endpoints included stent patency at 1 , 2 , 3 , and 6 months , gastric outlet obstruction scoring system ( GOOSS ) scores at 14 days and 1 , 2 , 3 , and 6 months after stent deployment , technical success , adverse events , and patient survival ( ie , confirmed duration of the implant ) . RESULTS Technical success was achieved in 99.1 % of stent placements . Stent patency at 14 days was 94.6 % . Kaplan-Meier estimates of stent patency were 92.9 % at 1 month , 86.2 % at 2 months , 81.9 % at 3 months , and 63.4 % at 6 months . At 14 days , GOOSS scores increased by a median of 1 point . The overall GI adverse event rate was 32.4 % ; however , the stent-related adverse event rate was 19.4 % . The median implant duration was 47 days ( range 0 - 
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The meta- analysis of surgical and endoscopic stent treatment showed no difference in the technical success and overall number of complications .
Conclusions : In the palliation of malignant GOO , covered SEMS had higher migration and lower obstruction rates when compared with uncovered stents .
Surgery is associated with lower reintervention rates than stents