Endoscopic duodenal stent versus surgical gastrojejunostomy for gastric outlet obstruction in patients with advanced pancreatic cancer

Uemura, Shiro; Iwashita, Takuji; Iwata, Koichi; Mukai, Tsuyoshi; Osada, Shinji; Sekino, Takafumi; Adachi, Takahito; Kawai, Masahiko; Yasuda, Ichiro; Shimizu, Masahito

doi:10.1016/j.pan.2018.04.015

Cited by 45 publications

(50 citation statements)

References 38 publications

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“…Duodenal stent placement is minimally invasive and associated with favorable short-term results, such as fast relief of symptoms and improvement in food intake. However, a significant risk of late adverse events (AEs) was found, such as stent migration and recurrent obstruction, often necessitating reintervention 3 4 5 6 7 . SGJ provides longer-lasting patency with less need for reinterventions once the anastomosis is functioning and patients have recovered 3 8 9 10 , but it is a more invasive treatment and associated with surgery-related morbidity such as gastroparesis or intestinal paralysis 11 .…”

Section: Introductionmentioning

confidence: 99%

Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

et al. 2020

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Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) is a novel, minimally invasive technique in the palliative treatment of malignant gastric outlet obstruction (GOO). Several studies have demonstrated feasibility and safety of EUS-GE, but evidence on long-term durability is limited. The aim of this study was to evaluate patency of EUS-GE in treatment of malignant GOO. Patients and Methods An international multicenter study was performed in seven centers in four European countries. Patients who underwent EUS-GE with a LAMS between March 2015 and March 2019 for palliative treatment of symptomatic malignant GOO were included retrospectively. Our main outcome was recurrent obstruction due to LAMS dysfunction; other outcomes of interest were technical success, clinical success, adverse events (AEs), and survival. Results A total of 45 patients (mean age 69.9 ± 12.3 years and 48.9 % male) were included. Median duration of follow-up was 59 days (interquartile range [IQR] 41–128). Recurrent obstruction occurred in two patients (6.1 %), after 33 and 283 days of follow-up. Technical success was achieved in 39 patients (86.7 %). Clinical success was achieved in 33 patients (73.3 %). AEs occurred in 12 patients (26.7 %), of which five were fatal. Median overall survival was 57 days (IQR 32–114). Conclusions EUS-GE showed a low rate of recurrent obstruction. The relatively high number of fatal AEs underscores the importance of careful implementation of EUS-GE in clinical practice.

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Section: Introductionmentioning

confidence: 99%

Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

et al. 2020

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“…Meta-analyses comparing extrahepatic and intrahepatic access routes for EUS-BD fund similar technical and functional success rates in both routes but adverse events were less frequent with the extrahepatic route in one analysis (32,41,42). In essence the choice of access route is dependent on the factors of patient's anatomy, local expertise and personal preference (42,43). When it comes to choice of stents for EUS-BD the aim is to establish a tight connection between the gastrointestinal and the biliary tract to avoid biliary leakage and peritonitis.…”

Section: Endosonographic Biliary Drainage (Eus-bd)mentioning

confidence: 90%

“…Duodenal or gastric outlet obstruction is common in patients with advanced pancreatic cancer and the most established therapeutic options for this problem are operative gastroenterostomy and the implantation of an endoluminal gastroduodenal SEMS (GDS) ( Figure 1C). Retrospective comparative studies quite homogeneously showed a shorter in hospitalization without significant differences in complications, reinterventions and survival between the groups (42,56,57), with higher score of patency for the surgical patients in the early follow up, but similar rates in the later follow up and earlier oral food intake and shorter time to chemotherapy in the GDS groups (42,57). The complications and risks of GDS include stent migration and blockage from food, debris or tumor ingrowth, as well as bleeding, perforation and blocking the ampulla, possibly causing pancreatitis or cholangitis.…”

Section: Gastroduodenal Obstructionmentioning

confidence: 93%

“…In both measures, it seems to take several years of intense practice in an average tertiary center to achieve expertise to reduce interventional complications. Meta-analyses comparing extrahepatic and intrahepatic access routes for EUS-BD fund similar technical and functional success rates in both routes but adverse events were less frequent with the extrahepatic route in one analysis (32,41,42). In essence the choice of access route is dependent on the factors of patient's anatomy, local expertise and personal preference (42,43).…”

Section: Endosonographic Biliary Drainage (Eus-bd)mentioning

confidence: 96%

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Palliative therapy in pancreatic cancer—interventional treatment with stents

Waldthaler¹,

Rutkowski²,

Valente³

et al. 2019

Transl. Gastroenterol. Hepatol

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Interventional treatment with stents in pancreatic cancer is a topic that developed during recent years and new fields of palliative stent therapy have evolved. The increasing life expectancy of patients with unresectable pancreatic cancer increases the need for clinical and cost effective therapeutic interventions. Current literature, guidelines, practice and evidence were reviewed. Besides the most obvious biliary stenting via endoscopic retrograde cholangiopancreatography (ERCP), pancreatic and gastroduodenal stenting as well as percutaneous transhepatic cholangiography (PTC) and the rapidly growing field of endosonographic stent implantation in the palliative care of patients with pancreatic cancer are being discussed from several points of view in this review.

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“…Symptom recurrence is attributed to tumor ingrowth and stent migration[ 31 ]. Despite recurrence, additional duodenal stent placement has been shown to be feasible and effective[ 31 , 32 ]. Stent design continues to advance and covered stents were designed to mitigate tumor ingrowth, but were found to have a high rate of migration[ 33 ].…”

Section: Duodenal Obstructionmentioning

confidence: 99%

Current role of palliative interventions in advanced pancreatic cancer

Ciambella¹,

Beard²,

Miner³

2018

WJGS

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Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Unfortunately, at diagnosis, most patients are not candidates for curative resection. Surgical palliation, a procedure performed with the intention of relieving symptoms or improving quality of life, comes to the forefront of management. This article reviews the palliative management of unresectable pancreatic cancer, including obstructive jaundice, duodenal obstruction and pain control with celiac plexus block. Although surgical bypasses for both biliary and duodenal obstructions usually achieve good technical success, they result in considerable perioperative morbidity and mortality, even when performed laparoscopically. The effectiveness of self-expanding metal stents for biliary drainage is excellent with low morbidity. Surgical gastrojejunostomy for duodenal obstruction appears to be best for patients with a life expectancy of greater than 2 mo while endoscopic stenting has been shown to be feasible with good symptom relief in those with a shorter life expectancy. Regardless of the palliative procedure performed, all physicians involved must be adequately trained in end of life management to ensure the best possible care for patients.

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Endoscopic duodenal stent versus surgical gastrojejunostomy for gastric outlet obstruction in patients with advanced pancreatic cancer

Cited by 45 publications

References 38 publications

Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

Palliative therapy in pancreatic cancer—interventional treatment with stents

Current role of palliative interventions in advanced pancreatic cancer

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