Elsevier

Gastrointestinal Endoscopy

Volume 60, Issue 6, December 2004, Pages 1010-1017
Gastrointestinal Endoscopy

Case Study
Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice?

https://doi.org/10.1016/S0016-5107(04)02276-XGet rights and content

Background

Gastroduodenal obstruction is a common preterminal event for patients with gastric and pancreatic cancer who often undergo palliative surgical bypass. Endoscopic palliation with self-expanding metallic stents has emerged as a safe and an effective alternative to surgery, but experience with the technique remains limited.

Methods

Twenty-eight patients hospitalized with GI obstruction because of incurable gastric or pancreatic cancer were recruited for a prospective study of palliation with self-expanding metallic stents. Complications and clinical outcomes were assessed.

Observations

Stent insertion was technically successful in 26 patients. Thereafter, 24 patients resumed an adequate liquid or semisolid diet. Stent insertion facilitated hospital discharge for 20 patients. Occlusion of the stent because of tumor ingrowth occurred in 3 patients, but there was no complication related to stent insertion or the stent itself.

Conclusions

Endoscopic placement of a self-expanding metallic stent is a simple, effective means of palliation for patients with malignant gastroduodenal obstruction.

Section snippets

Patients and methods

Twenty-eight patients were hospitalized with unresectable gastric or pancreatic cancer and symptoms of gastroduodenal obstruction. Written informed consent was obtained from patients for participation in a prospective study of palliative gastroduodenal stent insertion, and a consensus for the inclusion of each patient was reached after discussion with the GI cancer multidisciplinary team of our hospital.

The patients were admitted with symptoms of proximal GI obstruction, characterized by weight

Technical success

Stent deployment was technically successful in 26 of 28 patients (93%). The total duration of the procedure was 30 to 60 minutes.

Deployment was unsuccessful in two patients. In the first, the stent introducer (an early model enteral Wallstent) became kinked as it was inserted through the accessory channel of the endoscope, thereby preventing successful placement of the stent. In the second case, a guidewire could not be passed through the tumor. Both patients subsequently underwent successful

Discussion

Malignant obstruction of the stomach and the duodenum is a distressing complication of gastric and pancreatic cancer that results in inexorable deterioration of patient quality of life. Laparoscopic gastrojejunostomy provides suboptimal palliation for many patients,1., 2. requires conversion to open laparotomy in 20% of cases, and delays resumption of normal gut function by approximately 10 days.3 Because of the limitations of surgery and that many patients are elderly and frail, various

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    Preliminary data were presented in poster format at the British Society of Gastroenterology, March 24–26, 2003, Birmingham, United Kingdom (Holt A, Hulley C, Ahmed M. Endoscopically placed metal stents for the palliation of malignant gastroduodenal obstruction [abstract]. Gut 2003;52(1 Suppl): A73).

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