Survival and clinical outcome after endoscopic duodenal stent placement for malignant gastric outlet obstruction: comparison of pancreatic cancer and nonpancreatic cancer

Oh, Stephen; Edwards, Alicia; Mandelson, Margaret T.; Ross, Andrew; Irani, Shayan; Larsen, Michael; Gan, S. Ian; Glück, Michael; Picozzi, Vincent J.; Helton, Scott; Kozarek, Richard A.

doi:10.1016/j.gie.2015.01.026

Cited by 60 publications

(58 citation statements)

References 36 publications

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“…Predictive factors for gastroduodenal SEMS dysfunction have been reported. Chemotherapy after uncovered SEMS placement has been associated with longer stent patency as a result of prevention of local tumor progression, although interpretation of these findings may need caution to potential bias derived from the between‐group difference in the baseline hazard of cancer‐related death . Furthermore, tumor shrinkage as a result of effective chemotherapy and a resultant reduction in anchoring by the tumor may increase the risk of covered SEMS migration .…”

Section: Discussionmentioning

confidence: 99%

“…42,51 Predictive factors for gastroduodenal SEMS dysfunction have been reported. Chemotherapy after uncovered SEMS placement has been associated with longer stent patency as a result of prevention of local tumor progression, 16,[52][53][54][55] although interpretation of these findings may need caution to potential bias derived from the between-group difference in the baseline hazard of cancer-related death. [56][57][58] Figure 4 Meta-analysis of overall adverse events associated with covered and uncovered self-expandable metal stents (SEMS) for non-resectable malignant gastric outlet obstruction.…”

Section: Gastroduodenal Sems Dysfunctionmentioning

confidence: 99%

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Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta‐analysis

Hamada

Hakuta

Takahara

et al. 2017

Digestive Endoscopy

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Background and Aim: Self-expandable metal stents (SEMS) are used for non-resectable malignant gastric outlet obstruction (GOO). Studies of covered versus uncovered SEMS have yielded inconsistent results as a result of heterogeneity in design and patient population. We carried out a meta-analysis to compare covered and uncovered gastroduodenal SEMS.Methods: Using MEDLINE, Embase, and the Cochrane database, we identified 1624 patients from 13 prospective and retrospective studies that evaluated covered and uncovered SEMS for malignant GOO and were published until October 2016. We pooled data on SEMS dysfunction, technical and clinical success, and adverse events using the fixed-effect or random-effects model. Conclusions: Outcomes of covered and uncovered gastroduodenal SEMS were comparable, although the lower dysfunction rate of covered SEMS observed in the analysis of randomized trials needs further investigation. Antimigration mechanisms for covered SEMS and identification of patients who can achieve longer patency from uncovered SEMS would help improve the outcomes of gastroduodenal SEMS. Results

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Section: Discussionmentioning

confidence: 99%

Section: Gastroduodenal Sems Dysfunctionmentioning

confidence: 99%

Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta‐analysis

Hamada

Hakuta

Takahara

et al. 2017

Digestive Endoscopy

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“…Additionally, when a patient with poor functional status presents with a malignant gastric outlet obstruction from pancreatic cancer, outcomes with either procedure are routinely poor with a median survival of 2 months. [44] In this setting, another option that should be considered is placement of a decompressive percutaneous endoscopic gastrostomy (PEG) to allow for pleasure feeds, or direct consultation of hospice services for symptom control.…”

Section: Gastric Outlet Obstructionmentioning

confidence: 99%

Palliative Care for Pancreatic and Periampullary Cancer

Perone

Riall

Olino

2016

Surgical Clinics of North America

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Synopsis Most patients with pancreatic cancer will present with metastatic or locally advanced disease. [1–3] Unfortunately, the majority of patients with localized disease will recur even after multi-modality therapy including surgical resection combined with neoadjuvant or adjuvant chemotherapy. As such, pancreatic cancer patients arrive at a common endpoint where decisions pertaining to palliative care come to the forefront. This chapter summarizes surgical, endoscopic and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient’s and family’s goals to guide decision-making and choose “the right treatment, for the right patient, in the right setting.”

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“…It has also been suggested that aggressive tumors such as pancreatic cancers tend to have shorter times for stent occlusion that other type of malignancies. 51 In most cases the reobstruction is treated with additional stent placement with excellent technical and clinical success rates. The occlusion rates after secondary SEMS placement varies from 10% to 34%.…”

Section: Stent Dysfunctionmentioning

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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Survival and clinical outcome after endoscopic duodenal stent placement for malignant gastric outlet obstruction: comparison of pancreatic cancer and nonpancreatic cancer

Cited by 60 publications

References 36 publications

Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta‐analysis

Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta‐analysis

Palliative Care for Pancreatic and Periampullary Cancer

Enteral stents: Complications and their management

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