Palliation of Malignant Upper Gastrointestinal Obstruction with Self-Expandable Metal Stent

Abstract

ObjectiveTo assess the technical success, ability to eat, complications and clinical outcomes of patients with self-expandable metal stent (SEMS) placed for malignant upper gastrointestinal (GI) obstruction.Materials and MethodsData was collected retrospectively on patients who underwent SEMS placement for palliation of malignant upper GI obstruction by reviewing hospital charts from June 1998 to May 2011. Main outcome measurements were technical success, gastric outlet obstruction scoring system (GOOSS) score before and after treatment, complications, and survival.ResultsA total of 82 patients underwent SEMS placement with malignant upper GI obstruction. The initial SEMS placement was successful in 77 patients (93.9%). The mean GOOSS score was 0.56 before stenting and 1.92 (p < 0.001) after treatment. Complications arose in 12 patients (14.6%): stent migration in 1 patient (1.2%), perforation in 1 (1.2%), and obstruction of stent due to tumor ingrowth in 10 (12.2%). The median survival time after stenting was 52 days (6-445).ConclusionSEMS placement is an effective and safe treatment for palliation of malignant upper GI obstruction. It provides lasting relief in dysphagia and improves the QOL of patients.

Outcomes of endoscopic pyloric stenting in malignant gastric outlet obstruction: a retrospective study

“…In comparing our outcomes with the literature, we found that our technical and clinical success rates were comparable to most studies [26-28,30], although the study by Kim et al had better clinical outcomes in terms of longer stent patency related to the effect of chemotherapy [31]. Subgroup analysis of our patients who received chemotherapy did not show a significant difference in GOOSS score by day 28 post-stenting when compared with those who had not received chemotherapy.…”

“…Clearly, however, the number of patients was too small to establish any clinical significance. Although serious complications associated with SEMS insertion have been reported, such as gastrointestinal hemorrhage, sepsis, cholangitis, bowel perforation and aspiration pneumonia [18,27,29,30], the incidence of such complications is low, with most complications being non-fatal [27-30,32]. In our study, there were no incidents of stent-related bowel perforation, aspiration pneumonia, cholangitis or sepsis.…”

“…Complications were seen in 12 (14.6%) patients, with 10/12 developing stent blockade due to tumor ingrowth and one patient each with stent migration and perforation. Median survival post stenting was 52 days (range 6-445 days) [30]. …”

Percutaneous Enteral Stent Placement Using a Transhepatic Access for Palliation of Malignant Bowel Obstruction after Surgery

“…Self-expandable metal stent placement has been widely utilized for the treatment of malignant gastrointestinal obstruction in patients not eligible for surgery [ 1 ]. Endoscopy [ 2 3 ] or fluoroscopy [ 4 5 ] guided peroral stent placement is technically feasible in most patients with native bowel anatomy.…”

Self-expandable metallic stent application for the management of upper gastrointestinal tract disease

“…Owing to recent technological advances in endoscopic devices and the introduction of novel stent materials, the endoscopic approach has become the first option (1,(4)(5)(6)(7). This approach has been widely used owing to its minimally invasive nature and feasibility under mild sedation (8)(9)(10)(11)(12)(13)(14)(15)(16). The aim of the present study was to share with the readers our experience of using self-expandable metallic stents (SEMSs) for the treatment of complications involving the upper gastrointestinal tract, such as fistula and stricture.…”