***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Malignant gastrointestinal obstruction is a secondary complication of cancers in an advanced state . Treatment has consisted of gastrojejunostomy . However , the endoscopic placement of metallic stents has provided positive results . This study aim ed to compare the efficiency of both therapeutic options . Methods A total of 41 patients with gastrointestinal obstruction caused by inoperable neoplasm were treated endoscopically with enteral stent ( 24 patients ) or gastrojejunostomy ( 17 patients ) . Results In the endoscopic group ( EG ) 24 patients ( 100 % ) achieved efficient gastric emptying , as compared with 82.3 % in the surgical group ( SG ) . The difference was not significant . The average time for initiating oral food tolerance was 2.4 days for the EG and 5 days for the SG ( p < 0.001 ) . The average inpatient time was 7.1 days for the EG and 11.5 days for the SG ( p < 0.001 ) . Mortality at 30 days was lower in the EG ( 16.6 % ) than in the SG ( 29.4 % ) ( p < 0.05 ) . The survival time was 20 weeks for the EG and 21.6 weeks for the SG . The difference was not significant . The rate of complications was 4 % in the ( EG ) and 17.6 % in the ( SG ) , with the difference was not significant . Conclusion Endoscopic treatment of malignant gastrointestinal obstruction provides an adequate palliation of the symptoms . It is less invasive , avoids the morbidity associated with open gastrojejunostomy , and achieves a faster start to oral food and a shorter hospital stay , leading to a higher quality of life 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 ) Gastric outlet obstruction is a common , often preterminal , event for patients with inoperable neoplasms of the distal stomach , duodenum , and biliopancreatic area . It can be surgically managed by open or laparoscopic gastrojejunostomy . This study aim ed to compare the results of open and laparoscopic palliative gastrojejunostomy for patients with gastric outlet obstruction result ing from inoperable neoplasms . A total of 24 patients were r and omized prospect ively to undergo laparoscopic ( 12 patients ) or open ( 12 patients ) palliative laterolateral antecolic isoperistaltic gastrojejunostomy .  All the procedures were completed as planned . The mean duration of surgery was not significantly different between the two groups ( p = 0.75 ) . The mean intraoperative blood loss was significantly less after laparoscopic gastrojejunostomy ( LGJ ) ( p = 0.0001 ) . Time to oral solid food intake was longer after open gastrojejunostomy ( OGJ ) ( p = 0.04 ) . Two patients in the OGJ group experienced postoperative delayed gastric empting , whereas no patients in the LGJ group experienced such a complication ( p = 0.04 ) . The mean postoperative stay was shorter in the LGJ group , but the difference did not reach statistical significance ( p = 0.65 ) . No readmissions were registered after a minimum follow-up period of 2 months . The findings show that LGJ is a safe , feasible , and effective alternative to OGJ . However , because the current data involved only a small number of patients , large studies still are required for further evaluation of the this operation ’s effectiveness Gastroduodenal outlet obstruction is a complication of advanced gastrointestinal malignant disease . In the past it was usually treated by an open surgical bypass procedure . During the last decade , endoscopic self-exp and able stents ( SEMS ) have been used . The aim of this study was to compare these two palliative strategies concerning clinical outcome and health economy . A series of 36 patients with incurable malignant disease and gastroduodenal outlet obstruction syndrome were treated in a prospect i ve study . According to the attending hospital and endoscopist on duty , 21 of the 36 patients were endoscopically treated with SEMS and 15 underwent an open surgical gastroenteroanastomosis .  Health economic evaluation was based on the monetary charges for each patient associated with the procedure , postoperative care , and hospital stay . The hospital stay was 7.3 days for the stented group compared with 14.7 days for the open surgery group ( p > 0.05 ) . The survivals were 76 and 99 days , respectively ( NS ) . In the stented group all 15 patients ( 100 % ) alive after 1 month were able to eat or drink , and 11 ( 73 % ) of them tolerated solid food . In the surgical bypass group,9 out of 11 ( 81 % ) patients alive after 1 month could eat or drink , and 5 of them ( 45 % ) could eat solid food . The mean charges ( U.S. dollars ) during the hospital stay were $ 7215 for the stented group and $ 10,190 for the open surgery group ( p < 0.05 ) . Palliation of the gastroduodenal obstruction in patients with malignant disease were at least as good , and the charges were lower for the endoscopic stenting procedure than for an open surgical bypass 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 . ) AIM  Gastrojejunostomy ( GJJ ) and duodenal stent placement are the most commonly used palliative treatment modalities for gastric outlet obstruction ( GOO ) . In this retrospective study , we compared GJJ and stent placement with regard to medical effects . METHODS Medical records of 95 patients who had undergone palliative treatment between 1994 and 2006 in a Dutch university hospital , were review ed . Study outcomes were improvement of food intake , complications , persistent and recurrent symptoms , re- interventions , hospital stay , and survival . RESULTS Fifty-three patients were referred for duodenal stent placement and 42 patients underwent GJJ .  There were no differences in technical and clinical success and the incidence of minor and early major complications and survival . Food intake improved more rapidly after stent placement than GJJ ( P = 0.01 ) . The time to late major complications , recurrent obstructive symptoms and re-intervention was significantly shorter after stent placement than GJJ ( P = 0.004 , 0.002 , and 0.004 , respectively ) . Hospital stay was also shorter after stent placement than GJJ ( P < 0.001 ) . CONCLUSION These findings suggest that stent placement is associated with better short-term outcomes and GJJ with better long-term outcomes . A large r and omized controlled trial is however needed to systematic ally compare stent placement with GJJ with regard to medical effects , quality of life and costs BACKGROUND Gastric outlet obstruction ( GOO ) is most commonly a complication of advanced distal gastric , periampullary , or duodenal malignancy . Palliation of obstruction is the primary aim of treatment in most of these patients . Self-exp and able metal stents have emerged as an effective treatment option . OBJECTIVE Our purpose was to investigate the efficacy and safety of a newly developed enteral metal stent ( WallFlex ) . DESIGN Prospect i ve multicenter cohort study . SETTING Three tertiary referral centers ( 2 academic ) . PATIENTS Fifty-one consecutive patients with symptomatic malignant GOO from January 2005 to February 2006 . INTERVENTION Placement of a self-exp and able metallic stent ( WallFlex ) . MAIN OUTCOME MEASUREMENTS The primary end point was defined as improvement of the GOO scoring system for the remainder of the patients ' lives . Secondary end points focused on efficacy and safety and global quality of life . RESULTS The Gastric Outlet Obstruction Scoring System score improved ( P < .001 ) , the body mass index decreased ( P < .001 ) , and the World Health Organization performance score improved ( P = .002 ) when the score before stenting was compared with the mean score until death . Global quality of life did not improve 
    Output:
    
The time to recurrence of obstructive symptoms may have increased slightly following duodenal stenting ( RR 5.08 , 95 % CI 0.96 to 26.74 ; moderate- quality evidence ) .Due to very low- quality evidence , we were uncertain whether surgical palliation improved serious and minor adverse events .
The use of duodenal stent placement in malignant gastric outlet obstruction has the benefits of a quicker resumption of oral intake and a reduced inpatient hospital stay ; however , this is balanced by an increase in the recurrence of symptoms and the need for further intervention .
It was not possible to analyse the impact on quality of life each intervention had for these participants