Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study

Telford, Jennifer J.; Carr‐Locke, David L.; Baron, Todd H.; Tringali, Andrea; Parsons, Willis G.; Gabbrielli, Armando; Costamagna, Guido

doi:10.1016/s0016-5107(04)02228-x

Cited by 175 publications

(135 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Finally, stent placement in the distal duodenum has the advantage that malignant biliary obstruction occurring after duodenal stent placement is not precluding the possibility to perform biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) at a later time point. Biliary obstruction occurs in 2-8 % of patients after stent placement in the proximal duodenum [1,2,20,21]. It is often difficult or even impossible to cannulate the papilla through the mesh of an uncovered stent.…”

Section: Discussionmentioning

confidence: 99%

Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

et al. 2008

View full text Add to dashboard Cite

Background Stent placement in the distal duodenum or proximal jejunum with a therapeutic gastroscope can be difficult, because of the reach of the endoscope, loop formation in the stomach, and flexibility of the gastroscope. The use of a colonoscope may overcome these problems. Objective To report our experience with distal duodenal stent placement in 16 patients using a colonoscope. Methods Multicenter, retrospective series of patients with a malignant obstruction at the level of the distal duodenum and proximal jejunum and treated by stent placement using a colonoscope. Main outcome measurements are technical success, ability to eat, complications, and survival. Results Stent placement was technically feasible in 93% (15/16) of patients. Food intake improved from a median gastric outlet obstruction scoring system (GOOSS) score of 1 (no oral intake) to 3 (soft solids) (p = 0.001). Severe complications were not observed. One patient had persistent obstructive symptoms presumably due to motility problems.Recurrent obstructive symptoms were caused by tissue/ tumor ingrowth through the stent mesh [n = 6 (38%)] and stent occlusion by debris [n = 1 (6%)]. Reinterventions included additional stent placement [n = 5 (31%)], gastrojejunostomy [n = 2 (12%)], and endoscopic stent cleansing [n = 1 (6%)]. Median survival was 153 days. Conclusion Duodenal stent placement can effectively and safely be performed using a colonoscope in patients with an obstruction at the level of the distal duodenum or proximal jejunum. A colonoscope has the advantage that it is long enough and offers good endoscopic stiffness, which avoids looping in the stomach.

show abstract

Section: Discussionmentioning

confidence: 99%

Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Telford et al [20] reported no tumour ingrowth of uncovered stents in gastric outlet obstruction, but the majority of patients included had pancreatic cancer, bile duct cancer or other metastatic cancer. Intra-luminal malignancies, such as gastric cancer, can induce tumour ingrowth with uncovered stents, whereas extra-luminal tumours, such as pancreatic cancer, show a different growth pattern and there is a lower risk of tumour ingrowth [20,28].…”

Section: Treatment Of Malignant Gastroduodenal Obstruction 849mentioning

confidence: 99%

Palliative treatment of malignant gastroduodenal obstruction with metallic stent: prospective comparison of covered and uncovered stents

Lee

Choi

Shin

et al. 2009

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

Background. The placement of self-expandable metallic stents (SEMS) is known to be effective palliative treatment of malignant gastroduodenal obstruction. There are two types of SEMS Á covered and uncovered Á each with its own advantages and disadvantages. This study was conducted to compare between the clinical outcomes of covered and uncovered stents in patients with malignant gastroduodenal obstruction. Patients and methods. The study was conducted prospectively from January 1998 to June 2007 and 154 patients were included. All had symptomatic gastroduodenal obstruction and were not candidates for curative operation. Seventy patients received covered SEMS, while the other 84 received uncovered SEMS. We compared technical and clinical success rates, tumour ingrowth rate, stent migration rate, stent patency time and patient survival in both SEMS groups. Results. The technical and clinical success rates of the covered and uncovered stent groups did not differ. Stent migration was more frequent in the covered stent group than in the uncovered group (17.1% versus 0%; p00.0001). Tumour ingrowth was more frequent in the uncovered stent group than in the covered group (16.6% versus 2.9%; p00.0066). Stent re-intervention rate, stent patency time and patient survival did not differ between groups. Conclusion. Covered and uncovered stent insertions are technically feasible and effective palliative treatment of malignant gastroduodenal obstruction. Covered stents can reduce the risk of tumour ingrowth, whereas uncovered stents are effective in preventing stent migration. However, covered stents did not differ from uncovered stents in regard to other clinical outcomes.

show abstract

“…The reported rate for adverse events including stent dysfunction after deployment of SEMS for patients with malignant GOO is 15-48% ( Table 1) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The rates of stent dysfunction and other adverse events are 5-40% and 0-23%, respectively.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…Table 1 shows clinical results of prospective and multicenter studies of endoscopic treatment using SEMS for patients with malignant GOO. These reports show a technical success rate for the endoscopic deployment of a SEMS in patients with malignant GOO ranging from 95-100% (Table 1) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Reasons for unsuccessful deployment of a SEMS included unsuccessful passage of the guidewire or stent delivery system because of severity of the stricture (8,12), perforation during the procedure (9,16), insufficient deployment (11), and functional problems with SEMSs (6).…”

Section: Introductionmentioning

confidence: 99%

“…Reasons for unsuccessful deployment of a SEMS included unsuccessful passage of the guidewire or stent delivery system because of severity of the stricture (8,12), perforation during the procedure (9,16), insufficient deployment (11), and functional problems with SEMSs (6). Though definitions of clinical success differ slightly among studies, the rates of clinical success, which are indicated by an improvement in the GOO ranged from 77-94% (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Median survival after deployment of a SEMS was reported to be approximately 3 months or less in most reports.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction

2017

View full text Add to dashboard Cite

Gastric outlet obstruction (GOO) is one of severe comorbidities caused by many kinds of malignant diseases and is associated with not only degradation of patients' quality of life but also mortality. Although surgical bypass is one of the main therapies for malignant GOO, it is often difficult to perform in end-stage patients. The deployment of self-expandable metallic stents (SEMSs) has recently become a viable alternative to surgical bypass for malignant GOO. This technique is less invasive and more effective, particularly in patients with poor prognoses.Many reports have referred to the feasibility, effectiveness, and safety of the placement of SEMSs for malignant GOO. According to these reports, the rates of technical and clinical success were reported to be relatively high and the rate of adverse events to be acceptable. However, precautions against severe adverse events such as massive bleeding and perforation are necessary. Several reports have described the differences in clinical results among different kinds of SEMSs. The presence of a covered design for SEMSs may affect the patency of SEMSs and the rate of stent dysfunction. Selection of the SEMS according to axial force may affect successful achievement of long patency of SEMSs and avoidance of gastroduodenal perforation at the bending site of the duodenum. Compared with high technical success rates nearing 100%, clinical success rates were usually lower than technical success. Therefore, determination of predictive factors for failure of clinical success is important. Several papers reported that low performance status could be associated with failure of clinical success. However, the association of clinical success with other factors such as carcinomatosa and ascites remains controversial, which is a problem to be solved.Reintervention with SEMS using the stent-in-stent method after stent dysfunction can be performed effectively as well as placement of the first SEMS.

show abstract

Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study

Cited by 175 publications

References 16 publications

Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

Palliative treatment of malignant gastroduodenal obstruction with metallic stent: prospective comparison of covered and uncovered stents

Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction

Contact Info

Product

Resources

About