Malignant Gastric Outlet Obstructions: Treatment with Self-Expandable Metallic Stents

Unresectable malignant gastric outlet obstruction (GOO) severely affects the quality of life, with complications that include nausea, vomiting, aspiration, pain, and malnutrition. Although palliative surgical procedures have been traditionally performed, they are associated with high morbidity and mortality rates. Placing self-expandable metallic stents is associated with higher clinical success rates, lower morbidity, shorter time from the procedure to starting oral intake, lower incidence of delayed gastric emptying, and a shorter hospital stay than palliative surgery. Fluoroscopic or endoscopic placement of either bare or covered self-expandable metallic stents is a safe, nonsurgical, palliative treatment option for unresectable malignant GOOs, with a high clinical success rate and a low rate of serious complications. Stent obstruction and migration are the most common complications, but most can be managed by interventional treatments. Although there have been substantial developments in stent design over the past decade, large prospective, randomized studies are required to determine the ideal stent for malignant GOOs.

The Usefulness of Applying an Additional Clip When Using a Double-layered Pyloric Stent to Treat Gastric Outlet Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: It has been reported the placement of a double-layered pyloric combination stent can overcome the disadvantage of the increased ingrowth observed for an uncovered stent and the increased migration for a covered stent. But this did not satisfactorily prevent stent migration and it caused stent migration more frequently than with using the uncovered stent. This study evaluated the usefulness of applying a clip in an effort to reduce stent migration. METHODS: Fifteen patients with malignant gastric outlet obstruction were treated with endoscopic placement of a double-layered combination pyloric stent. Three endoscopic clips were then applied to fix the proximal end of the enteral stent to the gastric or duodenal mucosa. The clinical efficacy and especially the rate of migration were analyzed. RESULTS: The technical and clinical success rate was 100% (15/15) and 93.3% (14/15), respectively. No stent migration was observed in any of the patients. Three patients (20%) experienced complications such as stent collapse. The median stent patency period was 83.4 days. CONCLUSIONS: Endoscopic clipping for enteral stent placement is effective for preventing stent migration in patients with malignant gastric outlet obstruction.

Uncovered Self-expandable Metal Stents (SEMS) for Gastric Outlet Obstruction Caused by Stomach Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: The use of self-expandable metal stents (SEMS) is a safe and efficacious method for palliating malignant gastric outlet obstruction. However, few reports have assessed clinical outcome after the insertion of SEMS for malignant gastric outlet obstruction caused by stomach cancer. The aim of this study was to assess the usefulness of uncovered SEMS in patients with malignant gastric outlet obstruction caused by stomach cancer. METHODS: We evaluated 62 patients with gastric outlet obstruction caused by stomach cancer treated by the implantation of uncovered SEMS. A total of 62 patients (43 males, 19 females) were treated between August 2000 and March 2007. A scoring system was used to grade the ability to eat. RESULTS: Stent implantation was successful in 61 (98.4%) patients. Relief of obstructive symptoms was achieved in 49 (80.3%) patients. The mean survival duration was 143 days. The mean stent patency time was 103.5 days. An improvement in the ability to eat using the scoring system was statistically significant (p<0.05). CONCLUSIONS: Endoscopic placement of uncovered SEMS is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.