Su1034 OUTCOMES OF PALLIATIVE TREATMENT FOR MALIGNANT GASTROINTESTINAL OBSTRUCTION WITH PERITONEAL CARCINOMATOSIS: STENT PLACEMENT VERSUS PALLIATIVE SURGERY AND PREDICTORS OF STENT FAILURE

Abstract Background and study aims Management of malignant gastrointestinal obstruction (MGIO) is more challenging in the presence of peritoneal carcinomatosis (PC). Outcomes data to guide the management of MGIO with PC are lacking. We aimed to compare the clinical outcomes and adverse events between endoscopic and surgical palliation and identify predictors of stent success in patients with MGIO with PC. Patients and methods Consecutive inpatients with MGIO with PC between 2000 and 2018 who underwent palliative surgery or enteral stenting were included. Clinical success was defined as relief of obstructive symptoms. Results Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared. The two groups did not differ in rates of technical success, 30-day mortality, or recurrence. Clinical success from a single intervention (63.2 % versus 95 %), luminal patency duration (27 days vs. 145 days), and survival length (148 days vs. 336 days) favored palliative surgery (all P < 0.05) but the patients in the surgery group had a trend toward better Eastern Cooperative Oncology Group (ECOG) status. The rate of adverse events (AEs) (10.5 % vs. 50 %), the severity of AEs, and length of hospital stay (4.5 days vs. 9 days) favored enteral stenting (P < 0.05). The need for more than one stent was associated with a higher likelihood of stent failure. Conclusions Our study suggests that enteral stenting is safer and associated with a shorter hospital stay than palliative surgery, although unlike other MGIOs, clinical success is lower in MGIO with PC. Identification of the right candidates and potential predictors of clinical success in ECOG-matched large-scale studies is needed to validate these results.

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Usefulness of Percutaneous Transesophageal Gastro-tubing as Palliative Treatment for Peritoneal Carcinomatosis and Palliative Surgery for Gastrointestinal Obstruction

Nihon Ika Daigaku Igakkai Zasshi ◽

10.1272/manms.3.128 ◽

2007 ◽

Vol 3 (3) ◽

pp. 128-135

Author(s):

Shunji Kato ◽

Takeshi Okuda ◽

Itsuo Fujita ◽

Naoyuki Yamashita ◽

Teruo Kiyama ◽

...

Keyword(s):

Peritoneal Carcinomatosis ◽

Palliative Treatment ◽

Palliative Surgery ◽

Gastrointestinal Obstruction

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The effectiveness and long-term outcomes of carcinomatosis and ascites status of palliative treatment in the patients of advanced gastric cancer with bowel obstruction : stent placement versus palliative surgery

10.26226/morressier.57c53841d462b80296c9c4da ◽

2016 ◽

Author(s):

Yong eun Park

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Bowel Obstruction ◽

Stent Placement ◽

Palliative Treatment ◽

Palliative Surgery ◽

Long Term Outcomes

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Covered Metal Stent after Dysfunction of Uncovered Stents for Palliation of Gastrointestinal Malignant Obstruction

GE Portuguese Journal of Gastroenterology ◽

10.1159/000507200 ◽

2020 ◽

Vol 27 (6) ◽

pp. 383-390

Author(s):

Marta Patita ◽

Rui Castro ◽

Diogo Libânio ◽

Rui Pedro Bastos ◽

Rui Silva ◽

...

Keyword(s):

Adverse Events ◽

Palliative Treatment ◽

Clinical Success ◽

Outlet Obstruction ◽

Metal Stents ◽

Consecutive Series ◽

Stent Patency ◽

Gastrointestinal Obstruction ◽

Tertiary Center ◽

Malignant Gastrointestinal Obstruction

Background: Self-expanding metal stents (SEMS) have been used for the palliative treatment of malignant gastrointestinal tract obstruction. However, restenosis or incomplete expansion of a first stent is a frequent complication, and the effectiveness of reintervention with placement of a second stent is still controversial. Objective: To evaluate the clinical outcomes of covered SEMS (cSEMS) placement after dysfunction of uncovered SEMS (uSEMS) by the stent-in-stent technique. Patients and Methods: We retrospectively studied a consecutive series of patients receiving palliative treatment for malignant gastrointestinal obstruction with cSEMS placement after uSEMS dysfunction in a tertiary center from January 2013 to August 2018. Technical and clinical success, time of patency, and adverse events were analyzed. Results: Twelve patients were included; their mean age was 60 ± 9 years. Eleven patients had gastric outlet obstruction, and 1 patient had compression of the transverse colon due to gastric neoplasia. In 5 cases, there was absence of early clinical success with uSEMS and stent dysfunction in 7 cases (median patency time: 81 days). There was 100% technical success and 91.7% clinical success after cSEMS placement. There were no adverse events nor need for reintervention. The median patency time after placement of both stents was 163 days (vs. 71 days with the initial stent). Conclusion: cSEMS placement after uSEMS dysfunction is technically feasible and a clinically effective treatment for patients with recurrent malignant gastrointestinal obstruction, with good stent patency in the medium/long term. This approach seems to be safe and without increase in adverse effects.

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Endoscopic metallic stenting by double-balloon enteroscopy and its overtube for malignant gastrointestinal obstruction as palliative treatment

Digestive Endoscopy ◽

10.1111/den.12136 ◽

2013 ◽

Vol 25 (5) ◽

pp. 552-553 ◽

Cited By ~ 12

Author(s):

Akihiko Kida ◽

Koichiro Matsuda ◽

Yatsugi Noda

Keyword(s):

Palliative Treatment ◽

Double Balloon Enteroscopy ◽

Balloon Enteroscopy ◽

Double Balloon ◽

Gastrointestinal Obstruction ◽

Malignant Gastrointestinal Obstruction

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Tu1072 MANAGEMENT OF RECURRENT MALIGNANT GASTROINTESTINAL OBSTRUCTION IN PATIENTS WITH PERITONEAL CARCINOMATOSIS AND THE PREDICTORS OF OUTCOME

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.3244 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB532-AB533

Author(s):

FNU Chesta ◽

Veeravich Jaruvongvanich ◽

Meher Oberoi ◽

Zaheer H. Rizvi ◽

Alyssa J. Meyer ◽

...

Keyword(s):

Peritoneal Carcinomatosis ◽

Predictors Of Outcome ◽

Gastrointestinal Obstruction ◽

Malignant Gastrointestinal Obstruction

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Palliative surgery for malignant gastrointestinal obstruction: A community hospital experience

Annals of Cancer Research and Therapy ◽

10.4993/acrt.27.80 ◽

2019 ◽

Vol 27 (2) ◽

pp. 80-82

Author(s):

Megumi Sano ◽

Shinichi Asaka ◽

Masaya Satake ◽

Jun Kinoshita ◽

Masaki Matsumura ◽

...

Keyword(s):

Community Hospital ◽

Palliative Surgery ◽

Gastrointestinal Obstruction ◽

Hospital Experience ◽

Malignant Gastrointestinal Obstruction

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Malignant Gastrointestinal Obstruction: Options for Decompression and Nutrition

Digestive Disease Interventions ◽

10.1055/s-0040-1718390 ◽

2020 ◽

Vol 04 (03) ◽

pp. 311-322

Author(s):

Robert J. Litwin ◽

Johanna L. Chan ◽

Steven Y. Huang

Keyword(s):

Clinical Presentation ◽

Practice Patterns ◽

Patient Care Team ◽

Therapeutic Interventions ◽

Collaborative Approach ◽

Malignant Bowel Obstruction ◽

Advanced Malignancy ◽

Gastrointestinal Obstruction ◽

Malignant Gastrointestinal Obstruction

AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.

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Acute malignant obstruction in patients with peritoneal carcinomatosis: The role of palliative surgery

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2018.12.015 ◽

2019 ◽

Vol 45 (3) ◽

pp. 389-393 ◽

Cited By ~ 5

Author(s):

Nadine L. de Boer ◽

Jan A.W. Hagemans ◽

Bob T.A. Schultze ◽

Alexandra R.M. Brandt-Kerkhof ◽

Eva V.E. Madsen ◽

...

Keyword(s):

Peritoneal Carcinomatosis ◽

Palliative Surgery ◽

Malignant Obstruction

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The Role of Nursing in Caring for Patients Receiving Palliative Surgery or Chemotherapy

Oxford Textbook of Palliative Nursing ◽

10.1093/med/9780190862374.003.0054 ◽

2019 ◽

pp. 660-669

Author(s):

Virginia Sun ◽

Tami Tittelfitz ◽

Marjorie J. Hein

Keyword(s):

Palliative Treatment ◽

Symptom Control ◽

Palliative Surgery ◽

Treatment Modalities ◽

Indications For Surgery ◽

Role Of Nursing ◽

Definition Of ◽

Treatment Intent

Surgery and chemotherapy are common treatment modalities used to manage disease and symptoms in palliative settings where the disease is incurable. These treatment modalities can lead to deteriorations in a patient’s quality of life (QOL). The benefits of palliative surgery and chemotherapy should always focus on QOL, symptom control, and symptom prevention. The purpose of this chapter is to provide an overview of the definition of palliative surgery and chemotherapy, describe common indications for surgery and chemotherapy for palliative treatment intent, and discuss the role of nursing in caring for patients who are receiving palliative surgery and chemotherapy.

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