Case StudyPalliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice?
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
References (30)
- et al.
Surgical treatment of gastric cancer: proximal, mid and distal stomach
Surg Clin North Am
(1992) - et al.
Laparoscopic gastroenterostomy for duodenal obstruction
Am J Surg
(1995) - et al.
Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients
Am J Gastroenterol
(2002) - et al.
Palliative dilation of esophageal carcinoma
Gastrointest Endosc
(1985) - et al.
Duodenal obstruction caused by pancreatic head carcinoma: palliation with self-expandable endoprostheses
Gastrointest Endosc
(1997) - et al.
Palliation of malignant gastric outlet obstruction using an endoscopically placed Wallstent
Gastrointest Endosc
(1998) - et al.
Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction
Gastrointest Endosc
(2001) - et al.
Fluoroscopic guided covered metallic stent placement for gastric outlet obstruction and post-operative gastroenterostomy anastomotic stricture
Clin Radiol
(2001) - et al.
Initial experience with Song's covered duodenal stent in the treatment of malignant gastroduodenal obstruction
J Vasc Interv Radiol
(2001) - et al.
Malignant gastric outlet obstructions: treatment by means of coaxial placement of uncovered and covered expandable nitinol stents
J Vasc Interv Radiol
(2002)
Gastrojejunostomy: is it helpful for patients with pancreatic cancer?
Surgery
Endoscopic laser therapy in the curative and palliative treatment of upper gastrointestinal cancer
World J Surg
Obstructing cancer of the gastric antrum: palliative treatment with covered metallic stents
Radiology
Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents
Radiology
Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, British Society of Gastroenterology, British Association of Surgical Oncology. Guidelines for management of oesophageal and gastric cancer
Gut
Cited by (117)
EUS-guided gastroenteric anastomosis as a bridge to definitive treatment in benign gastric outlet obstruction
2020, Gastrointestinal EndoscopyPalliative Management of Advanced Peritoneal Carcinomatosis
2018, Surgical Oncology Clinics of North AmericaChapter 69 - Palliative treatment of pancreatic and periampullary tumors
2016, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionPredictors of self-expanding metallic stent dysfunction in malignant gastric outlet obstruction
2020, Revista de Gastroenterologia de Mexico
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).