Role of self-expandable metal stents in the palliation of malignant duodenal obstruction

Kaw, Madhukar; Singh, Sandeep; Gagneja, Harish K.; Azad, P.

doi:10.1007/s00464-002-8527-1

Cited by 77 publications

(49 citation statements)

References 45 publications

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“…Additionally, the composition of enrolled patients was relatively uniformed (periampullary cancer with most of them were pancreas head cancer), and these strengths are contrasted to the heterogenous characteristics of previously reported data [2][3][4][5][6][7][8][9][10] in terms of adopted SEMS types, endoscopic and interventional techniques, and performed endoscopists and interventional radiologists.…”

Section: Discussionmentioning

confidence: 43%

“…Patients with periampullary cancer frequently develop symptomatic biliary and duodenal obstruction. [2][3][4] Historically, such patients have been treated by surgical bypass procedures such as hepaticojejunostomy or choledochojejunostomy for biliary obstruction and gastrojejunostomy for duodenal or gastric outlet obstruction. 5,6 Palliative management of biliary and duodenal stenosis in patients with unresectable periampullary cancer is effective in enhancing the quality of life of patients and in reducing pruritus, ascending cholangitis, vomiting and cachexia.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of biliary and duodenal self-expandable metal stent placements for palliative treatment in patients with periampullary cancer

Kim

2017

Int J Gastrointest Interv

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Background: Endoscopic self-expandable metal stent (SEMS) insertions for palliation of malignant biliary and duodenal obstructions have been revealed to be an effective treatment. We present our clinical experience with the use of SEMS for malignant biliary and duodenal obstructions caused by periampullary cancer. Methods: We performed a retrospective review of all patients who underwent endoscopic biliary and duodenal SEMS insertion for palliation of malignant biliary and duodenal obstruction caused by periampullary cancer between July 2007 and October 2016. The patients received simultaneous or sequential endoscopic biliary stenting and duodenal stenting with COMVI TM stents (partially covered; Taewoong, Seoul, Korea). Results: The final diagnoses of our enrolled patients were 15 pancreas head cancer, and 3 distal common bile duct (CBD) cancer. The main stricture site in the duodenum was bulb (n = 4, 22.2%), 2nd portion (n = 9, 50.0%), and 3rd portion (n = 5, 27.8%). The technical success rates of CBD and duodenal stenting were 100% (18/18), and 100% (18/18), respectively. The clinical success rates of CBD and duodenal stenting were 100% (18/18), and 88.9% (16/18), respectively. Median actuarial stent patency for biliary and duodenal SEMS were 6.5 months (range, 1-12 months) and 4.5 months (range, 1-14 months), respectively. Three patients (16.7%) had recurrent biliary obstruction and all of them underwent percutaneous trans-hepatic biliary drainage (PTBD) with biliary SEMS reinsertion. Three other patients (16.7%, totally different from patients with CBD restenosis) had recurrent duodenal obstruction and all of them underwent upper gastrointestinal endoscopy with duodenal SEMS reinsertion. Conclusion: Endoscopic SEMS insertions for simultaneous palliation of malignant biliary and duodenal obstruction in patients with periampullary cancer may provide a safe, and less invasive alternative to surgical palliation with a successful clinical outcome.

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Section: Discussionmentioning

confidence: 43%

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of biliary and duodenal self-expandable metal stent placements for palliative treatment in patients with periampullary cancer

Kim

2017

Int J Gastrointest Interv

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“…Gastric cancer patients present with an unresectable tumor in up to 40% of cases (1,2). Gastric outlet obstruction (GOO) is a frequent complications and presents as nausea, vomiting, dehydration and eventually malnutrition.…”

Section: Introductionmentioning

confidence: 99%

Self-expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum

Alonso-Lárraga

Alvaro-Villegas

Sobrino-Cossío

et al. 2012

Rev. esp. enferm. dig.

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Background: gastric cancer patients are first diagnosed with an unresectable tumor in up to 40% of cases. Gastric outlet obstruction causes nausea, vomiting, dehydration and malnutrition. The aim of the study was to compare self-expanding metal stents to antrectomy and Roux-en Y gastrojejunostomy for palliation of obstructive adenocarcinoma of the gastric antrum.Methods: retrospective study in patients with obstructing cancer of the gastric antrum. Patients were divided into two groups: group A, underwent endoscopic placement of self-expanding metal stents and group B underwent surgical treatment with antrectomy and Roux-en Y gastrojejunostomy. Collected data included: age, gender, performance status (Karnofsky's score), body mass index, histopathology, clinical stage (TNM classification), technical and clinical success of the procedure, time to oral intake, in-hospital stay, reintervention rate, and complications related to the treatment and survival.Results: a total of 39 patients with gastric adenocarcinoma were included, 21 male and 18 female. Nineteen patients were assigned to group A and 20 patients to group B. There were no statistically significant differences between groups in regards to age, body mass index, Karnofsky's score and clinical stage. The technical and clinical success was similar for both groups. There was a statistically significant difference between groups favoring self-expanding metal stent in time to oral intake (1 ± 0 vs. 4.9 ± 0.6 days, p = 0.0001) and in-hospital stay (0.94 ± 1.18 vs. 7.8 ± 7.7 days, p = 0.0005). We did not find statistically significant differences with regards to long-term survival.Conclusions: in patients with malignant gastric outlet obstruction due to gastric cancer, endoscopic palliation with self-expanding metal stents provide a shorter interval to oral intake, shorter inhospital stay and lower rate of complications.Key words: Self-expanding metal stents. Antrectomy. Gastric cancer. INTRODUCTIONGastric cancer patients present with an unresectable tumor in up to 40% of cases (1,2). Gastric outlet obstruction (GOO) is a frequent complications and presents as nausea, vomiting, dehydration and eventually malnutrition. Most patients at this stage have a short life expectancy if left without treatment (3-5). Open gastrojejunostomy (OGJ) has been considered the preferred treatment for relieving malignant GOO with good results and adequate symptom relief in most cases. Early major complications of OGJ can be seen in 6% of patients and late complications in up to 17%, and are similar to those of self-expanding metal stents (SEMS) (6% for early and 18% for late complications) (6). However, OGJ has a higher overall mortality when compared to SEMS (29 vs. 17%; p < 0.001) (7).Patients with OGJ have delayed gastric emptying, which can decrease oral intake for up to 8 days (8). While laparoscopic gastrojejunostomy is less invasive, adequate gastrointestinal function can also be delayed for a similar period, with this approach (9). Gastric stents are less invasive than surge...

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“…[114][115][116][117][118][119][120][121][122] In most published reports symptom control and patient comfort are not described, and there is lack of uniformity on the assessment of quality of life. 123 Newer endoscopically placed stents 124 for gastric outlet obstruction offer the advantage of lower cost, the possibility of an outpatient procedure, and low risk of complications. Abdominal paracentesis or a permanent intraperitoneal catheter 125 may be helpful in the patient with nausea and ascites that does not respond to conventional therapy.…”

Section: Serotonin Antagonistsmentioning

confidence: 99%

Symptom Control in Palliative Care—Part I: Oncology as a Paradigmatic Example

Dalal

Fabbro

Bruera

2006

Journal of Palliative Medicine

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Achieving the best quality of life for patients and their families when a disease becomes progressive and no longer remains responsive to curative therapy is the primary goal of palliative care. A comprehensive care plan focusing on control of physical symptoms as well as psychological, social, and spiritual issues then becomes paramount in that context. Symptom assessment and treatment are a principle part of palliative care. This paper is the first of three in a series addressing non-pain symptoms, which are frequently encountered in the palliative care populations. The most frequent non-pain symptoms are constipation, chronic nausea and vomiting, anorexia, dyspnea, fatigue, and delirium. As symptoms are subjective, their expression varies from patient to patient, depending on the individual patient's perception and on other factors such as psychosocial issues. While symptoms are addressed individually, patients frequently have multiple coexisting symptoms. Generally told, once the intensity of a symptom has been assessed, it is necessary to assess the symptom in the context of other symptoms such as pain, appetite, fatigue, depression, and anxiety. Given that fact, adopting a multidimensional assessment allows for formulation of a more effective therapeutic strategy. More pertinently, this paper highlights the management of non-pain symptoms as an integral part of patient care and reviews the pathophysiologies, causes, assessment, and management of constipation, chronic nausea, and vomiting, each of which is common among the palliative care population. 391

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Role of self-expandable metal stents in the palliation of malignant duodenal obstruction

Abstract: Self-expandable metal stents placed endoscopically provide a safe, less invasive palliative treatment option with good clinical outcome in the management of malignant gastric outlet-duodenal obstruction.

Cited by 77 publications

References 45 publications

Clinical outcomes of biliary and duodenal self-expandable metal stent placements for palliative treatment in patients with periampullary cancer

Clinical outcomes of biliary and duodenal self-expandable metal stent placements for palliative treatment in patients with periampullary cancer

Self-expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum

Symptom Control in Palliative Care—Part I: Oncology as a Paradigmatic Example

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