Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery

No, Jin Hee; Kim, Sang Woo; Lim, Chul-Hyun; Kim, Jin Su; Cho, Yu Kyung; Park, Jae Myung; Lee, In Seok; Choi, Myung-Gyu

doi:10.1016/j.gie.2013.01.041

Cited by 109 publications

(103 citation statements)

References 24 publications

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“…There have been mixed reports on the technical and clinical success rates, cost of procedure and complication rates. More commonly, studies found no difference between technical and clinical success rates [49][50][51]53], but in a meta-analysis of 307 procedures by Hosono et al [45], clinical success was higher in the stenting group. A recent 10-year retrospective study of stenting versus GJ by Khashab et al [46 •• ] found statistically higher rates of technical success in the GJ group (96 vs. 99 %).…”

Section: Emerging Technologiesmentioning

confidence: 98%

“…Both impact, major vs. minor, and timing, early versus late, have been studied. Mixed data have shown both no difference in early minor and major complications [49,50,53] and a decrease in time to late major complications in the stenting group [49,53]. Perhaps the most important statistic for patients is the length of post-procedure survival.…”

Section: Emerging Technologiesmentioning

confidence: 99%

“…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]. Given the higher rates of re-intervention for recurrent obstruction, palliative stenting may best be reserved for patients with shorter expected survival times.…”

Section: Emerging Technologiesmentioning

confidence: 99%

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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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Section: Emerging Technologiesmentioning

confidence: 98%

Section: Emerging Technologiesmentioning

confidence: 99%

Section: Emerging Technologiesmentioning

confidence: 99%

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Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction

Miller

Schwaitzberg

2014

Curr Surg Rep

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“…30 The higher reintervention rates and shorter patency of GD stents than surgery is mainly because of stent malfunction due to migration and stents occlusion. 30,34 Recent recommendations suggest that surgery may be a better option for patients where the expected survival is longer than 2 months, while patients with advanced disease, metastasis, severe malnutrition, concomitant biliary obstruction or poor performance status may benefit more from SEMS. 35,36 Nonetheless, SEMS placement is still considered the treatment of choice over surgical palliation in many institutions due to its less invasive nature.…”

Section: Gastric Outlet Obstruction (Goo) Is a Common Complicationmentioning

confidence: 99%

Enteral stents: Complications and their management

Lopera

Gregorio

Laborda

et al. 2016

Int J Gastrointest Interv

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The treatment of malignant colonic and gastric outlet obstruction with self-expanding metallic stents (SEMS) is an established technique that can be performed by radiologic or a combination of radiologic and endoscopic guidance. The procedure is very effective to relieve the obstructive symptoms of advanced malignancies, with important clinical benefits and significant improvement in quality of life for the patients. Despite much advancement in the designs of SEMS, enteral stent placement is still associated with some significant early and late complications. Stent dysfunction mainly caused by tumor ingrowth/over growth, and stent migration when covered stent are used, are relatively common complications and many times require reinterventions.

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“…In addition to such abdominal cancers, extra-abdominal cancers with lymph node metastasis and peritoneal dissemination of advanced cancers can cause malignant GOO. Surgical bypass traditionally has been a main treatment for malignant GOO and has been useful and feasible, especially in patients with a good performance status (1). However, performing a surgical procedure in end-stage patients is sometimes difficult.…”

Section: Introductionmentioning

confidence: 99%

Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction

2017

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Gastric outlet obstruction (GOO) is one of severe comorbidities caused by many kinds of malignant diseases and is associated with not only degradation of patients' quality of life but also mortality. Although surgical bypass is one of the main therapies for malignant GOO, it is often difficult to perform in end-stage patients. The deployment of self-expandable metallic stents (SEMSs) has recently become a viable alternative to surgical bypass for malignant GOO. This technique is less invasive and more effective, particularly in patients with poor prognoses.Many reports have referred to the feasibility, effectiveness, and safety of the placement of SEMSs for malignant GOO. According to these reports, the rates of technical and clinical success were reported to be relatively high and the rate of adverse events to be acceptable. However, precautions against severe adverse events such as massive bleeding and perforation are necessary. Several reports have described the differences in clinical results among different kinds of SEMSs. The presence of a covered design for SEMSs may affect the patency of SEMSs and the rate of stent dysfunction. Selection of the SEMS according to axial force may affect successful achievement of long patency of SEMSs and avoidance of gastroduodenal perforation at the bending site of the duodenum. Compared with high technical success rates nearing 100%, clinical success rates were usually lower than technical success. Therefore, determination of predictive factors for failure of clinical success is important. Several papers reported that low performance status could be associated with failure of clinical success. However, the association of clinical success with other factors such as carcinomatosa and ascites remains controversial, which is a problem to be solved.Reintervention with SEMS using the stent-in-stent method after stent dysfunction can be performed effectively as well as placement of the first SEMS.

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Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery

Cited by 109 publications

References 24 publications

Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction

Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction

Enteral stents: Complications and their management

Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction

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