Self-expandable metal stent of esophagogastric junction versus pyloric area obstruction in advanced gastric cancer patients

Abstract

Upper gastrointestinal stenting is a palliative treatment for relieving symptoms such as nausea, vomiting, and dietary intake in patients with obstruction due to inoperable advanced stomach cancer. Self-expandable metal stent (SEMS) implantation for malignant obstruction has recently become more effective, safer, and less expensive than operative modality. It also has better short-term outcomes, particularly a shorter hospital stay and a more rapid return to oral intake, than surgical treatment. However, there is no comparative analysis regarding the efficacy, side effects, and survival rate of stenting between the esophagogastric junction (EGJ) and pyloric obstructions. To compare the prognoses and complications after SEMS implantation between EGJ and pyloric obstructions in advanced gastric cancer. Among advanced gastric cancer patients with gastrointestinal obstruction diagnosed from January 2008 to December 2017 at the Gastroenterology Department of Chungnam National University Hospital, 42 and 76 patients presented with EGJ (EGJ obstruction group) and gastric pyloric obstructions (pyloric obstruction group), respectively. We retrospectively reviewed the survival period, changes in food intake, and complications of these patients before and after SEMS placement. The prevalences of aspiration pneumonia were 11.9% (5/42) and 2.6% (2/76) in the EGJ and pyloric obstruction groups, respectively, before SEMS placement ( P value: .041). Other symptoms associated with gastric malignant obstruction were not statistically different between the groups. Success rate and adverse events did not significantly differ between the EGJ and pyloric obstruction groups. There was no difference in frequency of stent reinsertion procedures performed owing to reobstruction, but the reprocedure average period was statistically significantly longer in the EGJ obstruction group [EGJ obstruction: 158.3 days (±42.4); pyloric obstruction: 86.0 days (±29.1)] ( P value: .022). As an index of improved dietary status, the Gastric Outlet Obstruction Scoring System score was not significantly different between the groups before and after SEMS placement. The EGJ and pyloric obstruction groups did not significantly differ in prognosis or complication rates. However, EGJ stent was more stable than pyloric stent when reobstruction was considered.

Prognostic importance of the preoperative New‐Naples prognostic score for patients with gastric cancer

“…This further indicates that there is a difference between CRC and GC in peripheral blood immunity. In addition, GC occurs in the upper digestive tract may cause a series of clinical symptoms, such as vomiting, regurgitation, dysphagia, and malignant obstruction, that lead to nutrient intake and absorption disorders 12 . By contrast, CRC occurs in the lower digestive tract has a limited impact on nutrient intake and absorption 13 .…”

“…The proportion of weight loss 2 weeks before surgery in patients with GC is higher than CRC (50% vs. 33%) 11 . This may be due to the occurrence of GC in the upper digestive tract, which may cause dysphagia and malignant obstruction and result in nutrient intake and absorption disorders 12 . However, the occurrence of CRC in the lower digestive tract has little effect on nutrient intake and absorption 13 .…”

“… 11 This may be due to the occurrence of GC in the upper digestive tract, which may cause dysphagia and malignant obstruction and result in nutrient intake and absorption disorders. 12 However, the occurrence of CRC in the lower digestive tract has little effect on nutrient intake and absorption. 13 Although the anatomical distance from the oral cavity to tumor site for CRC is farther than that for GC, the concentration of Fusobacterium in the oral flora is higher in CRC tissue than GC.…”

Palliative interventions for patients with advanced gastric cancer: a systematic review

“…Five studies described palliative endoscopic stenting for patients with AGC, including covered and uncovered endoscopically placed self-expandable metal stents (SEMS) of both custom and standard designs (see Table 5 and Figure 3) (41)(42)(43)(44)(45). All studies assessed outcomes after placement of an endoscopic SEMS.…”

Endoscopic stenting for stenosing cancer and digestive canal structures

“…Пластикові стенти мають більш високу ймовірність міграції (саморозправні пластикові стенти) і перфорації (несаморозправні пластикові стенти), ніж саморозправні металеві стенти (англ. Self-Expandable Metallic Stent -SEMS) [5][6][7]. Металеві стенти можуть бути покриті мембраною, зробленою з різних полімерних матеріалів, що забезпечує високу стійкість до проростання пухлиною.…”