Introduction Stent placement for malignant gastric outflow obstruction (GOO) is recommended for palliative management for patients with unresectable disease. Gastrojejunostomy is an alternative but may not be appropriate due to poor performance status and prognosis. Endoscopic SEMS for GOO is less invasive and has been shown to be safe and effective method for relieving symptoms of GOO. Previously reported endoscopic success rate of GOO stenting is 92–100%.1
Our aim was to assess the safety and efficacy of pyloric and duodenal stents (SEMS) for gastric outflow obstruction caused by malignancy.
Method Retrospective audit between Jan 2012 to Dec 2014, reviewing medical notes and electronic patient records. All procedures were performed using Through the Scope (TTS) technique and fluoroscopic guidance. End-points were technical success (correct SEMS placement confirmed radiologically and endoscopically at time of procedure) and clinical success (resolution of obstructive symptoms, resumption of oral diet).
Results 63 patients were identified (median age 71 years). 50 patients (79%) had malignant stricture due to primary cancers (gastric 33%, pancreatic 25%). 13 patients had GOO from metastases (20%). Median ASA grade was 3.
Procedural Success 4 patients did not require stent placement when evaluated endoscopically. Of the remaining 59 patients 55 were stented successfully (93.2%). In 4 patients stents could not be deployed as stricture could not be traversed with wire or cannula. Of the 55 patients who were stented clinical success was 96% (2 patients needed repeat procedure within one week). 13 patients (25%) required further interventions due to stent blockage from tumour ingrowth or food debris and all successfully managed with restenting. The mean time for further intervention 98 day. 83 procedures were carried in total with an overall success rate of 95.2%.
There were no major complications reported, no perforation or procedure related mortality. Two patient had stent migrated proximally into stomach and one patient needed repeat procedure due to lack of stent expansion, all managed with successful restenting.
Survival 78% were alive at 30 days, 32% were alive at 6 month with 4 patients yet to reach 6 month end point, 33% alive at 1 year.
Conclusion Stenting for GOO is a safe procedure and avoids the need for surgical gastroenterojejunostomy in over 93% of palliative patients. Stent dysfunction can happen due to tumour overgrowth, food debris or stent migration. In our study all 25% of patients needing reintervention within 4 months were successfully managed with restenting.
Disclosure of interest None Declared.
Gaidos JKJ. Treatment of malignant gastric outlet obs truction with endoscopically placed self -expandable metal stents. World J Gastroenterol 2009;15(35):4365–4371