Endoscopic Stenting for Malignant Gastric Outlet Obstruction

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Abstract

Background and Aims

Obstruction often gives rise to disabling symptoms in noncurable malignant upper gastrointestinal disease. Surgical relief is associated with high morbidity and mortality. We report outcomes of 24 patients palliated with endoscopic inserted stents.

Patients Studied

Thirteen females and 11 males, median age 66 years (range 24 to 88) suffered from gastroduodenal obstruction because of noncurable malignant disease. All patients had nausea, repeated vomiting, and weight loss. The obstruction was localized in the stomach (n=5), gastrojejunostomy (n=3), or the duodenum (n=16). Self-expanding metal stents were delivered endoscopically under fluoroscopic control.

Results

All patients got an improved quality of life and could eat at least semisolid food. All the patients were followed until they died. The median survival time after the procedure was 6.4 (range 0.5 to 23) months. In 1 patient stenting was complicated by perforation leading to death 2 weeks later. In another patient the stent migrated during the initial placement, but a secondary stent could be placed during the same procedure. Due to a long duodenal stenosis 2 patients got 2 stents under the primary procedure. During the follow-up period, 6 patients had supplementary gastroduodenal stents placed. Nine patients had biliary stents placed before the placement of the gastroduodenal stents, 2 after.

Conclusions

Our data suggest that endoscopic stenting for disabling symptoms due to gastroduodenal obstruction from noncurable malignant disease, gives good symptomatic improvement with only few complications.

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