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

Abstract

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 selfexpandable 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. (Gut Liver 2010; 4(Suppl. 1):S32-38)

Self-Expandable Metallic Stent Placement in Malignant Gastric Outlet Obstruction

“…The major complications mean life-threatening complications, such as aspiration pneumonia, sepsis, bleeding, and perforation. 12 …”

Bleeding after expandable nitinol stent placement in patients with esophageal and upper gastrointestinal obstruction: incidence, management, and predictors

“…In our series, early bleeding was often massive, and in these cases, it could be treated by embolization (16,18,28). Kos et al (16) reported a case of life-threatening esophageal bleeding after metal stent placement successfully treated by vascular embolization.…”

“…Several authors have reported that bleeding after metallic stent placement is a life-threatening complication (15)(16)(17). Conversely, others reported that it is a mild or self-limiting complication (8,11,(18)(19)(20)(21). To our knowledge, no study to date has evaluated the incidence or predictors of bleeding after esophageal and upper GI nitinol stent placement.…”

A Multicenter Randomized Controlled Trial of Malignant Gastric Outlet Obstruction: Tailored Partially Covered Stents (Placed Fluoroscopically) versus Standard Uncovered Stents (Placed Endoscopically)

“…However, unlike standard uncovered stents, we did not find restenosis of proximal ends of the GOO tailored stents, presumably because the big stent cups and funnels provided a wider space to accommodate tumor ingrowth and the covered part of the cup and funnel provided a barrier to tumor overgrowth. In the current study, two patients did not show improvements of symptoms after stent placement, which might be due to functional gastric outlet obstruction due to neural involvement of the tumor [ 15 , 33 , 34 ].…”