Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients

Adler, Douglas G.; Baron, Todd H.

doi:10.1111/j.1572-0241.2002.05423.x

Cited by 502 publications

(302 citation statements)

References 28 publications

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“…Finally, stent placement in the distal duodenum has the advantage that malignant biliary obstruction occurring after duodenal stent placement is not precluding the possibility to perform biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) at a later time point. Biliary obstruction occurs in 2-8 % of patients after stent placement in the proximal duodenum [1,2,20,21]. It is often difficult or even impossible to cannulate the papilla through the mesh of an uncovered stent.…”

Section: Discussionmentioning

confidence: 99%

“…Food intake was measured by the standardized gastric outlet obstruction scoring system (GOOSS score), with 1 = no oral intake, 2 = liquids only, 3 = soft solids, and 4 = full diet [2]. The GOOSS score was measured before and 1 week after stent placement.…”

Section: Follow-up Informationmentioning

confidence: 99%

“…The largest group consists of patients with pancreatic cancer, who develop in 10-20% of cases a gastric outlet obstruction (GOO) [1][2][3]. Other causes of GOO include periampullary carcinoma, lymphoma, primary duodenal carcinoma as well as metastases to the duodenum [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…Other causes of GOO include periampullary carcinoma, lymphoma, primary duodenal carcinoma as well as metastases to the duodenum [4][5][6]. Palliative treatment of GOO is mandatory as it is associated with a rapid deterioration of the clinical status due to vomiting, dehydration, and malnutrition [2].…”

Section: Introductionmentioning

confidence: 99%

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Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

et al. 2008

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Background Stent placement in the distal duodenum or proximal jejunum with a therapeutic gastroscope can be difficult, because of the reach of the endoscope, loop formation in the stomach, and flexibility of the gastroscope. The use of a colonoscope may overcome these problems. Objective To report our experience with distal duodenal stent placement in 16 patients using a colonoscope. Methods Multicenter, retrospective series of patients with a malignant obstruction at the level of the distal duodenum and proximal jejunum and treated by stent placement using a colonoscope. Main outcome measurements are technical success, ability to eat, complications, and survival. Results Stent placement was technically feasible in 93% (15/16) of patients. Food intake improved from a median gastric outlet obstruction scoring system (GOOSS) score of 1 (no oral intake) to 3 (soft solids) (p = 0.001). Severe complications were not observed. One patient had persistent obstructive symptoms presumably due to motility problems.Recurrent obstructive symptoms were caused by tissue/ tumor ingrowth through the stent mesh [n = 6 (38%)] and stent occlusion by debris [n = 1 (6%)]. Reinterventions included additional stent placement [n = 5 (31%)], gastrojejunostomy [n = 2 (12%)], and endoscopic stent cleansing [n = 1 (6%)]. Median survival was 153 days. Conclusion Duodenal stent placement can effectively and safely be performed using a colonoscope in patients with an obstruction at the level of the distal duodenum or proximal jejunum. A colonoscope has the advantage that it is long enough and offers good endoscopic stiffness, which avoids looping in the stomach.

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Section: Discussionmentioning

confidence: 99%

Section: Follow-up Informationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

et al. 2008

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“…GOOSS is point-scoring dependent on the patient's level of oral intake (no/inadequate oral intake 00; thickened liquids/liquid 01; semi-solids/low residue diet 02; unmodified diet 03) [7]. Patient characteristics are summarized in Table I; there was no difference in demographic features.…”

Section: Patientsmentioning

confidence: 99%

Palliative treatment of malignant gastroduodenal obstruction with metallic stent: prospective comparison of covered and uncovered stents

Lee

Choi

Shin

et al. 2009

Scandinavian Journal of Gastroenterology

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Background. The placement of self-expandable metallic stents (SEMS) is known to be effective palliative treatment of malignant gastroduodenal obstruction. There are two types of SEMS Á covered and uncovered Á each with its own advantages and disadvantages. This study was conducted to compare between the clinical outcomes of covered and uncovered stents in patients with malignant gastroduodenal obstruction. Patients and methods. The study was conducted prospectively from January 1998 to June 2007 and 154 patients were included. All had symptomatic gastroduodenal obstruction and were not candidates for curative operation. Seventy patients received covered SEMS, while the other 84 received uncovered SEMS. We compared technical and clinical success rates, tumour ingrowth rate, stent migration rate, stent patency time and patient survival in both SEMS groups. Results. The technical and clinical success rates of the covered and uncovered stent groups did not differ. Stent migration was more frequent in the covered stent group than in the uncovered group (17.1% versus 0%; p00.0001). Tumour ingrowth was more frequent in the uncovered stent group than in the covered group (16.6% versus 2.9%; p00.0066). Stent re-intervention rate, stent patency time and patient survival did not differ between groups. Conclusion. Covered and uncovered stent insertions are technically feasible and effective palliative treatment of malignant gastroduodenal obstruction. Covered stents can reduce the risk of tumour ingrowth, whereas uncovered stents are effective in preventing stent migration. However, covered stents did not differ from uncovered stents in regard to other clinical outcomes.

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Gastric Adenocarcinoma With Distant Metastasis

Sarela

Yelluri²

2007

Arch Surg

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Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients

Abstract: Self-expanding metal stents are a safe and efficacious method for palliating malignant gastric outlet obstruction. The majority of patients do not require reintervention, and those that do can usually be managed nonoperatively.

Cited by 502 publications

References 28 publications

Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

Palliative treatment of malignant gastroduodenal obstruction with metallic stent: prospective comparison of covered and uncovered stents

Gastric Adenocarcinoma With Distant Metastasis

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