Quality Assurance Guidelines for Placement of Gastroduodenal Stents

Sabharwal, Tarun; Irani, Farah Gillian; Adam, Andy

doi:10.1007/s00270-006-0110-z

Cited by 27 publications

(55 citation statements)

References 40 publications

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“…It leads to malnutrition and a decrease in the quality of life. Patients are at risk of aspiration and pneumonia (1). Obstruction greatly diminishes the quality of life in these patients who have a limited life expectancy (2).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…In fact, as initially metastatic cases did not undergo gastrectomy before, they embed the potential to cause the following complications: First, the remaining gastric lesion of initially metastatic case is at a high risk of bleeding or perforation. Second, if the gastric lesion grows enough to cause obstruction or stasis, the patient is predisposed to aspiration pneumonia [24,25,26,27]. Our data also included more patients who died of aspiration pneumonia in IM group, even though comparative analysis did not reach a statistically significant difference (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Is noncurative gastrectomy always a beneficial strategy for stage IV gastric cancer?

et al. 2017

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PurposeThe purpose of this study is to suggest a treatment strategy for stage IV gastric cancer by investigating the behavioral difference between initially and recurrent metastatic disease.MethodsWe reviewed the medical records of the patients who underwent chemotherapy alone for metastatic gastric cancer between January 2006 and September 2013. Patients were divided into those who underwent chemotherapy for metastatic disease since initial diagnosis (IM group) and for metastatic recurrence after curative surgery (RM group). Survival and causes of death were compared between the 2 groups, and significant prognostic factors were also investigated.ResultsA total of 170 patients were enrolled in this study. Of these patients, 104 were included in the IM group and 66 in the RM group. Overall survival of the IM group did not differ from that of RM (P = 0.569). In the comparison of the causes of death, the IM group had a greater tendency to die from bleeding (P = 0.054) and pneumonia (P = 0.055). In multivariate analysis, bone metastasis (P < 0.001; HR = 2.847), carcinoma peritonei (P = 0.047; HR = 1.766), and the frequency of chemotherapy (P < 0.001; HR = 0.777) were significantly associated with overall survival of IM group.ConclusionDisease-burden mainly contributes to the prognosis of metastatic gastric cancer, although noncurative gastrectomy may be helpful in reducing the mortality of initially metastatic disease. Therefore, disease-burden should be also prioritized in determining the treatment strategies for stage IV gastric cancer.

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“…6 Stent migration can be managed by insertion of another stent. 6,27,28 The migrated stent may pass out through the rectum or may be caught in the intestine and lead to ob- struction, requiring surgery.…”

Section: Stent Migrationmentioning

confidence: 99%

“…1,6,7,29,30 Complicated anatomy, severe stenosis, or acute angulation of a bowel loop may result in technical failure. 27 Technical success rates are dependent on the site of lesion. 6 For example, stent placement at the site of a duodenal obstruction is technically more difficult than in the peripyloric region, not only because of loop formation of the stent delivery system in the distended stomach but also because of the curved configuration of the duodenal C-loop.…”

Section: Technical and Clinical Successmentioning

confidence: 99%

“…6,12,26 The stent should be 2-4 cm longer than the stricture to reduce the risk of tumor overgrowth. 3,27 In patients with technical failure to negotiate the guide wire though the stricture under fluoroscopic guidance, the guide wire may be negotiated through the stricture under combined endoscopic and fluoroscopic guidance at the same sitting. In patients with strictures longer than 10 cm, two or three stents may be placed in a stent-within-stent fashion to achieve complete coverage of the stricture.…”

Section: Stent Placement Proceduresmentioning

confidence: 99%

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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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Quality Assurance Guidelines for Placement of Gastroduodenal Stents

Cited by 27 publications

References 40 publications

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

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

Is noncurative gastrectomy always a beneficial strategy for stage IV gastric cancer?

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

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