Mo1558 Comparison of the Effectiveness of Endoscopic Duodenal Stent Placement and Surgical Gastrojejunostomy for Gastric Outlet Obstruction in Patients With Advanced Pancreatic Cancer

patients receiving intensive oncologic therapy is unclear. Aim: To evaluate the clinical outcomes of patients following SEMS placement and identify risk factors for SEMS related adverse events (AE). Methods: Consecutive patients undergoing enteral SEMS placement for treatment of duodenal obstruction resulting from primary pancreatic or biliary malignancy at a single tertiary care center between 2008 and 2014 were retrospectively identified. Subjects were excluded if 1) a surgical bypass or Whipple resection had been performed prior to SEMS placement 2) no follow up data was available. Demographics, clinical characteristics, success rates and SEMS related adverse events (AE) were recorded. AE were categorized as early (!7 days) and late (O7 days). Results: 130 patients (average age 65.6 10.1 years, 47.7% female) underwent SEMS placement for palliation of duodenal obstruction due to PB cancer. The technical success of SEMS placement was 100% and there were no immediate complications. 33 patients were excluded, 8 had undergone a surgical bypass prior to SEMS placement, and 25 due to lack of follow up data. 97 patients (average age 65.3+/-9.8 years, 46.4% female) met the inclusion and exclusion criteria. There were 4 early AEs [3 stent occlusions, 1 gastrointestinal (GI) bleeding]. 31 (32.0%) patients experienced late SEMS related AE. AEs included 24 stent occlusions, 7 GI bleeds, and 3 perforations. SEMS related AEs were not associated with baseline demographics or post-stent cancer therapy (table 1). SEMS related adverse events were treated with repeat endoscopic intervention in 17, surgery in 3, and supportive measures in 11 cases. Following SEMS placement 30 patients underwent repeat upper endoscopy for evaluation and treatment of suspected complications. On Kaplan-Meyer analysis, the median time to a SEMS related AE was 225 (95% CI, 126-323) days. When patients were stratified on the basis of post-SEMS oncologic therapy (chemotherapy vs. chemo-radiation vs. palliative care alone) there was no difference in the median time to SEMS related AE (figure 1, log rank pZ0.43). Conclusion: SEMS placement is a safe and effective treatment of malignant duodenal obstruction in patients with locally advanced PB cancer. While 32% of patients do develop SEMS related AE during long term follow up, the majority of these are amendable to endoscopic intervention. Finally, we observed that aggressive oncologic therapy is not associated with an increased rate of SEMS related AEs.