Self-expanding metal stents as an alternative to surgical bypass for malignant gastric outlet obstruction

Background: Gastroduodenal obstruction due to malignancy can be difficult to palliate. Self‐expanding metal stents (SEMS) are gaining acceptance as an effective alternative to surgical bypass. Methods: Patients not suitable for surgical bypass, with complete gastric outlet obstruction as a result of...

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Bibliographic Details
Published in:British journal of surgery 2010-06, Vol.97 (6), p.872-876
Main Authors: Shaw, J. M., Bornman, P. C., Krige, J. E. J., Stupart, D. A., Panieri, E.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Feasibility Studies
Female
Gastric Outlet Obstruction - etiology
Gastric Outlet Obstruction - surgery
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Humans
Length of Stay
Male
Medical sciences
Middle Aged
Neoplasms - complications
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Salvage Therapy
Stents
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Tumors
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Summary:Background: Gastroduodenal obstruction due to malignancy can be difficult to palliate. Self‐expanding metal stents (SEMS) are gaining acceptance as an effective alternative to surgical bypass. Methods: Patients not suitable for surgical bypass, with complete gastric outlet obstruction as a result of malignancy, were offered palliation with SEMS from November 2004 to December 2008. The procedure was performed under fluoroscopic guidance and conscious sedation. Data were collected prospectively. Results: Seventy patients underwent SEMS placement (hepatobiliary and pancreatic malignancy, 44; antral gastric carcinoma, 19; other, seven). Follow‐up was complete in 69 patients (99 per cent). Technical and clinical success rates were 93 and 95 per cent respectively. Median hospital stay was 2 (range 1–18) days, median survival was 1·8 (0·1–19·0) months, and 87 per cent had improved intake after SEMS placement, as determined by Gastric Outlet Obstruction Severity Score before and after stenting (P < 0·001). Complications included two episodes of minor bleeding. Conclusion: The use of SEMS to alleviate complete malignant gastric outlet obstruction in patients with limited life expectancy is successful in re‐establishing enteral intake in most patients, with minimal morbidity, no mortality and a short hospital stay. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Nearly always works
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.6968