Endoscopic Stent Insertion for the Palliation of Malignant Gastric Outlet Obstruction

Abstract

Background/Aims: Controversy exists as to whether endoscopic or minimally invasive/open bypass is superior in cases of malignant gastric outlet obstruction. Methods: Retrospective observational study following those patients admitted to the hospital between January 1999 and December 2004 (n = 23) with gastric outlet obstruction. In all suitable patients endoscopic stent insertion was attempted. Symptomatic improvement was monitored as was time until discharge as well as need for readmission. We also recorded morbidity and mortality associated with the procedure as well as final survival in days. Results: Stents were inserted successfully in 21 patients. Two patients went on to have a laparoscopic bypass. Stent placement relieved obstructive symptoms in all patients. A median inpatient stay of 4 days was achieved (range 2–9 days). One patient was admitted with recurrent symptoms 9 months following his initial treatment. Investigation showed the distal end of the stent to be occluded by further tumor. His symptoms were relieved by the insertion of a second stent. In 19 patients death was due to metastatic disease. Operative mortality: cerebrovascular accident day 2 (n = 1), duodenal perforation day 4 (n = 1). Conclusion: Patients with malignant gastric outlet obstruction not suitable for resection should be assessed for insertion of an enteral stent.

Clinical outcomes of re-stenting in patients with stent malfunction in malignant gastric outlet obstruction

“…Endoscopic SEMS placement has been accepted as a safe and effective palliative treatment for malignant GOO that allows for oral intake [2,4,6]. However, obstructive symptoms can be problematic with a primary stent malfunction.…”

“…Relief from obstruction is an important goal to allow enteral feeding, as well as best supportive therapy for improving quality of life. Recently, the endoscopic placement of a self-expanding metal stent (SEMS) has been widely accepted as a palliative treatment for malignant GOO [1,2]. The advantages of SEMS placement include its low invasiveness and lower procedure-related morbidity and mortality rates [3].…”

Invited Commentary to "Treatment of malignant gastric outlet obstruction: endoscopic implantation of self-expanding metal stents versus gastric bypass surgery" (Eur Surg 38/6: 451–455, 2006)

“…Otherwise they underwent palliative gastro-enteric bypass surgery. This selection bias upvalues the data obtained in this study and should recommend the endoscopic placement of metal stents as the treatment of first choice [7]. A high risk for perforation or enteral ischemia or the inability to pass a guidewire across the stricture would count for a contraindication to endoscopic palliation.…”

Combined Intestinal and Biliary Stenting in Gastric Outlet and Biliary Obstruction

“…If the endodcopy could go cross the stenosis, the stent could be released under the surveillance of endoscopy; if not, we advanced the catheter and extra lubricity wire first, then X-ray was used to measure the range of the stenosis and to mark the both ends. The catheter must be guided by the wire and advanced to the ends as far as possible, then the hard extra lubricity wire was used in the upper jejunum in order to place the stent successfully, because the hard extra lubricity wire can not fold in the gastrointestinal tract [20-25]. …”