Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy

Abstract

Self-expandable metallic stent placement is a safe and efficacious procedure for palliation, with shorter operating time and more prompt restoration of oral intake, compared to surgical alternatives in patients with GOO caused by gastric cancer.

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

“…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.…”

Effective palliation and quality of life outcomes in studies of surgery for advanced, non-curative gastric cancer: a systematic review

“…Nine articles met the eligibility requirements and were included in the review (Fig. 1) [12][13][14][15][16][17][18][19][20]. All included articles were retrospective, single-institution case series, except for one [19] that included a prospective collection of patient-reported outcomes for a subset of patients using a questionnaire ( Table 1).…”

“…One study reported specifically the absence of symptoms in 13.2% of non-curatively managed patients [13]. An additional 3 of the 9 studies reported that all patients had unresectable, symptomatic gastric outlet obstruction (GOO) requiring palliation [14][15][16].…”

“…Instead, hospital chart abstraction and follow-up visits were used to collect palliative clinical endpoints in 8 studies [12][13][14][15][16][17][18]20] and an unvalidated questionnaire was used to collect information in 1 study [19]. Time to oral intake was the most common outcome used and it was reported in 5 of the 9 studies (Table 2).…”

“…Time to oral intake was the most common outcome used and it was reported in 5 of the 9 studies (Table 2). Results ranged from a median of 2.9 days (laparoscopic gastrojejunostomy) [14] to 8 days (surgical bypass) [16]. One study reporting on the management of GOO through surgical bypass noted that one patient was not able to return to a normal, solid diet due to complications incurred during the surgical bypass procedure [16,20].…”