Endoscopy or surgery for malignant GI outlet obstruction?

Piano, M. Del; Ballarè, M.; Montino, F.; Todesco, Annalisa; Orsello, M.; Magnani, Corrado; Garello, E.

doi:10.1016/s0016-5107(04)02757-9

Cited by 172 publications

(105 citation statements)

References 21 publications

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“…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]. 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%

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: Introductionmentioning

confidence: 99%

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

et al. 2008

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“…Most studies agree that stenting provides the following advantages over laparoscopic or open gastro-jejunostomy: shorter operative time, shorter hospital stay and decreased time to oral intake [44][45][46][47][48][49][50][51][52]. However, they almost universally report decreased patency of stents with higher rates of recurrent obstruction and need for re-intervention [46 •• , 49, 50, 53].…”

Section: Emerging Technologiesmentioning

confidence: 99%

“…Perhaps the most important statistic for patients is the length of post-procedure survival. Thirty-day survival has been reported as both no difference [45,48] and decreased for the stenting group [44]. However, mean survival seems to favor the GJ group over the stenting group (90-293 vs. 65-189 days) [50,52,53].…”

Section: Emerging Technologiesmentioning

confidence: 99%

Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction

Miller

Schwaitzberg

2014

Curr Surg Rep

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Gastric outlet obstruction (GOO) can be due to a variety of causes of both benign and malignant sources. As the etiology of GOO shifts from mostly benign to mostly malignant, treatment options have also evolved. Traditional options have only included surgery, but an increase in technology has seen the emergence of endoscopic alternatives. For benign disease, such as peptic ulcer disease, endoscopic balloon dilation has reduced the number of patients needing to undergo larger and more invasive surgical procedures. It has also proven successful in treating obstruction from stricture following bariatric surgery, but surgical revision or reversal remains the gold standard. Numerous surgical procedures have shown effectiveness when treating GOO, with new procedures constantly emerging. When malignancy is the cause, the procedural focus shifts from curative to palliative with the main focus being resumption of oral intake. Endoscopic stenting provides a viable alternative to gastro-jejunostomy, but due to problems with re-obstruction and stent migration, it should be reserved for patients with shorter life expectancies.

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Placement of self expandable metallic stents is associated with higher clinical success rates, less morbidity, shorter times from the procedure to starting oral intake, lower rates of delayed gastric emptying, and shorter hospital stay than palliative surgery. 13,14 This article reviews the use of this minimally-invasive therapeutic option in the palliative treatment of unresectable malignant GOOs.…”

Section: 25mentioning

confidence: 99%

Malignant Gastric Outlet Obstructions: Treatment with Self-Expandable Metallic Stents

2010

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Unresectable malignant gastric outlet obstruction (GOO) severely affects the quality of life, with complications that include nausea, vomiting, aspiration, pain, and malnutrition. Although palliative surgical procedures have been traditionally performed, they are associated with high morbidity and mortality rates. Placing self-expandable metallic stents is associated with higher clinical success rates, lower morbidity, shorter time from the procedure to starting oral intake, lower incidence of delayed gastric emptying, and a shorter hospital stay than palliative surgery. Fluoroscopic or endoscopic placement of either bare or covered selfexpandable metallic stents is a safe, nonsurgical, palliative treatment option for unresectable malignant GOOs, with a high clinical success rate and a low rate of serious complications. Stent obstruction and migration are the most common complications, but most can be managed by interventional treatments. Although there have been substantial developments in stent design over the past decade, large prospective, randomized studies are required to determine the ideal stent for malignant GOOs. (Gut Liver 2010; 4(Suppl. 1):S32-38)

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Endoscopy or surgery for malignant GI outlet obstruction?

Cited by 172 publications

References 21 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

Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction

Malignant Gastric Outlet Obstructions: Treatment with Self-Expandable Metallic Stents

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