Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction

6 Background: Decision-making for surgical palliation remains one of the most challenging clinical scenarios since quality of life (QOL) is a key component of cancer care. We conducted this study to examine the impacts of surgical palliation on postoperative QOL in patients (pts) with malignant gastric outlet obstruction (GOO) caused by incurable primary gastric cancer (GC). Methods: Eligibility included (1) no oral intake or liquids only requiring parenteral nutrition (2) aged ≥20 (3) surgically fit (4) ECOG PS of 0-2 and (5) written IC. Patients underwent either palliative distal/total gastrectomy (DG/TG) or gastrojejunostomy (GJS). Treatment choice was left to the discretion of the physician. Validated QOL instruments (EORTC QLQ-STO22 and EuroQol-5D) assessed QOL at baseline, 2 weeks (wks), 1 month (m), and 3 months following the surgical palliation, and two observational outcomes (postoperative improvement of oral intake, and safety of surgical intervention) were evaluated. Results: 104 pts, 71 males and 33 females with a median age of 68 years, were enrolled. The types of surgery were DG in 23 pts, TG in 9 pts, GJS in 70 in pts, and exploratory laparotomy in 2 pts. Baseline QOL questionnaires were completed by 103 (99.0%) pts. Among the 104 pts, 98 (94.2%), 100 (96.1%), and 81 (77.9%) completed the 2-wk, 1-m, and 3-m follow-up survey, respectively. The mean baseline EQ-5D score was 0.74 (SD, 0.21). During the follow-up period, the mean scores remained consistent with the baseline scores; the change from baseline score was within ± 0.05 for the index. Many pts came to eat solid food at 2 wks postsurgery and remained tolerable thereafter (from 0 at baseline to 82, 85, 75 pts at 2 wks, 1 m, and 3 ms, respectively). Overall morbidity rate of ≥grade 3 on Clavien-Dindo classification and 30-day postoperative mortality rate was 9.6% (10 pts) and 2.0% (2 pts) with a median hospital stay of 13 days and re-operation rate of 3.9% (4 pts). Conclusions: In pts with malignant GOO caused by advanced GC, surgical palliation maintained patient QOL while improving solid food intake with an acceptable surgical safety. Clinical trial information: UMIN000023494.

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Clinical outcomes in patients undergoing multiple self-expandable metallic stent placement by stent in stent technique for malignant gastric outlet obstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.88 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 88-88

Author(s):

Jinwon MO ◽

Jie-Hyun Kim ◽

Seung Yong Shin ◽

Da Hyun Jung ◽

Jae Jun Park ◽

...

Keyword(s):

Gastric Outlet Obstruction ◽

Stent Placement ◽

Clinical Success ◽

Outlet Obstruction ◽

Metallic Stent ◽

Sems Placement ◽

Stent Patency ◽

Malignant Gastric Outlet Obstruction ◽

The Third ◽

Expandable Metallic Stent

88 Background: Self-expandable metallic stent (SEMS) placement is widely used for relieving the obstructive symptoms of malignant gastric outlet obstruction (MGOO). The aims were to evaluate the efficacy and safety of multiple gastroduodenal stent placement by stent in stent technique and identify predictive factors about stent patency. Methods: We retrospectively analyzed data from 170 patients with GOO receiving SEMS by stent in stent technique from July 2006 to July 2018. Among them, 90 patients had been treated with gastroduodenal SEMS placement for MGOO. Technical and clinical success rates were evaluated. And, clinical outcomes with predictors of stent patency were also analyzed. Results: Among the subjects, 34.4% were treated with secondary SEMS placement, and 9.7% were treated with third SEMS placement because of the previous stent dysfunction. The median stent patency time was 15.7 weeks (range 0-89) in the first SEMS, 10.4 weeks (range 0-44) in the second SEMS, and 11.3 weeks (range 1-29) in the third SEMS. The technical and clinical success rate were 100% and 97.8% in the first SEMS, 100% and 90.3% in the second SEMS, 100% and 100% in the third SEMS. In multivariable analysis, the first SEMS placement of covered type including Comvi stent was correlated with prolonged stent patency (OR 4.549, P = 0.001). And both chemotherapy after the first SEMS placement (OR 8.248, P = 0.006) and chemotherapy after the second SEMS placement (OR 7.467, P = 0.003) were correlated with prolonged stent patency. Serious complications such as gastrointestinal hemorrhage or perforation did not occur in any patient. Conclusions: Secondary and third gastroduodenal SEMS placement by stent in stent technique is a safe and effective treatment for the first stent dysfunction in MGOO. The stent placement of covered type and chemotherapy after stent placement is the predictor of stent patency. Keywords: Malignant gastric outlet obstruction, Self-expandable metallic stent, Stent in stent technique, Stent patency, Predictive factor

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Early massive bleeding after duodenal self-expandable metal stent placement for palliation of malignant gastric outlet obstruction (with video)

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2010.12.034 ◽

2011 ◽

Vol 74 (6) ◽

pp. 1426-1427 ◽

Cited By ~ 4

Author(s):

Atif Saleem ◽

Johan Bakken ◽

Todd H. Baron

Keyword(s):

Gastric Outlet Obstruction ◽

Stent Placement ◽

Outlet Obstruction ◽

Massive Bleeding ◽

Metal Stent ◽

Malignant Gastric Outlet Obstruction ◽

Self Expandable Metal Stent

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Mo1062 Endoscopic Self-Expandable Metallic Stent Placement in Malignant Gastric Outlet Obstruction Due to Pancreatic Cancer: Does Chemotherapy Affect Stent Function?

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.03.573 ◽

2016 ◽

Vol 83 (5) ◽

pp. AB447

Author(s):

Naminatsu Takahara ◽

Hiroyuki Isayama ◽

Yousuke Nakai ◽

Shuntaro Yoshida ◽

Suguru Mizuno ◽

...

Keyword(s):

Pancreatic Cancer ◽

Gastric Outlet Obstruction ◽

Stent Placement ◽

Outlet Obstruction ◽

Metallic Stent ◽

Malignant Gastric Outlet Obstruction ◽

Expandable Metallic Stent ◽

Metallic Stent Placement

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Safety and efficacy of duodenal stent insertion for gastric outlet obstruction: characterisation of a regional district general hospital service

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0129 ◽

2020 ◽

Vol 102 (9) ◽

pp. 689-692

Author(s):

A Bryce ◽

JM Wohlgemut ◽

T Coyle ◽

J Hannay

Keyword(s):

General Hospital ◽

Gastric Outlet Obstruction ◽

Stent Placement ◽

Outlet Obstruction ◽

District General Hospital ◽

Stent Insertion ◽

Post Intervention ◽

Safety And Efficacy ◽

Malignant Gastric Outlet Obstruction ◽

Duodenal Stent

Introduction Placement of a duodenal or pyloric stent is a recognised palliative procedure for symptomatic relief of malignant gastric outlet obstruction. This procedure can be associated with significant complications, reinterventions and poor long-term relief of obstructive symptoms. However, there may be a faster return to diet and shorter hospital stay in comparison to other palliative procedures (eg gastrojejunostomy). The aim of this study was to determine the safety and efficacy of duodenal stenting in our regional district general hospital in comparison to that of larger tertiary centres. Materials and methods All patients with gastric outlet obstruction who had duodenal stent placement attempted in our region between 1 August 2013 and 31 July 2018 were identified by retrospective analysis of prospectively maintained coding databases and medical notes. Patient demographics, safety outcomes and efficacy outcomes were then extracted. Results were interpreted with respect to data from best available published evidence from larger tertiary centres. Results Of 43 duodenal stent insertion attempts, 84% had a successful return to diet, 18% underwent reintervention, 18% suffered adverse events, mean length of stay post-intervention was 8.6 days and mean survival post-intervention was 132 days. Conclusions Patients with malignant gastric outlet obstruction in whom duodenal stent placement was attempted had similar outcomes to published data from larger tertiary centres. Duodenal stent placement remains an acceptable treatment option for these patients in our region.

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