Stent placement versus surgical palliation for malignant gastric outlet obstruction

Upchurch, Emma; Cirocchi, Roberto; Ragusa, Mark

doi:10.1002/14651858.cd012506

Cited by 5 publications

(10 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mean cost of treatment with the big end double-layer uncovered SEMS was $2,945, which was higher than that with the individualized or funnel SEMS in China [10, 19]. Although the cost of the big end double-layer uncovered SEMS was higher, it was cost-efficient for the long-term run due to its lower reintervention rate (4.3%) and longer survival time (212.5 days) compared with monolayer SEMS [24–27]. Thus, the big end double-layer uncovered SEMS did not increase the total treatment cost for patients with GOO.…”

Section: Discussionmentioning

confidence: 99%

Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

Ding

Liu

et al. 2019

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Objectives. This study is aimed at evaluating the efficacy and safety of the big end double-layer uncovered self-expanding metal stents (SEMS) for the treatment of gastric outlet obstruction (GOO) caused by distal stomach cancer. Methods. Seventy three patients receiving big end double-layer uncovered SEMS for the treatment of GOO caused by distal gastric cancer will be included in this multicenter prospective clinical trial. The main outcome measures included the functional outcome, the complications, the reinterventional rates, the average treatment charges, and the mean survival time. Monthly telephone calls were needed to assess the food intake until the patients died. Results. The technical and the clinical success rates were 98.6%. The stent obstruction caused by tumor ingrowth was observed in one patient (1.4%). The incidence of food impaction was 2.9% (2/70) and the reinterventional rate was 4.3% (3/70). However, stent migration and obstruction caused by overgrowth were not observed. No perforation and severe bleeding were observed. The median cost of endoscopic stenting and total hospitalization (including reinterventions) for the big end double-layer uncovered SEMS in this study was $2945 and $3408, respectively. The mean survival time was 212.5 days. Conclusions. The placement of big end double-layer uncovered SEMS is a safe and effective modality and has the potential to be one of the options for the treatment of GOO caused by the distal gastric cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

Ding

Liu

et al. 2019

Gastroenterology Research and Practice

View full text Add to dashboard Cite

show abstract

“…Malignant disease accounts for an estimated 50 % to 80 % of cases of gastric outlet obstruction (GOO), with pancreatic cancer being the most common associated malignancy (15 %–20 %) 1 . Patients with GOO may experience progressively worsening nausea, vomiting, weight loss, abdominal pain and severe dehydration 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Patients with GOO may experience progressively worsening nausea, vomiting, weight loss, abdominal pain and severe dehydration 2 . Because patients with GOO secondary to an unresectable malignancy have limited life expectancy, palliative treatment prioritizes symptom resolution (especially relief of vomiting and return to oral intake) and minimization of hospital stays, complications and reinterventions 1 .…”

Section: Introductionmentioning

confidence: 99%

“…However, because stenting was associated with shorter survival time (mean difference 43 days) and higher rates of stent‑related complications, reobstruction and reintervention compared to surgical GJ, the authors concluded that surgical GJ was preferable for patients with a long life expectancy and good performance status 2 . A 2018 meta-analysis of the same treatments analyzed only three randomized controlled trials (RCTs) including 84 patients after exclusion of many studies for low-quality data 1 . This analysis confirmed that compared to surgical GJ, patients receiving duodenal stenting had a faster return to oral intake, shorter mean hospital stay, increased recurrence of symptoms and increased reintervention rate, while quality of life and survival could not be analyzed due to insufficient adequate-quality data 1 .…”

Section: Introductionmentioning

confidence: 99%

“…A 2018 meta-analysis of the same treatments analyzed only three randomized controlled trials (RCTs) including 84 patients after exclusion of many studies for low-quality data 1 . This analysis confirmed that compared to surgical GJ, patients receiving duodenal stenting had a faster return to oral intake, shorter mean hospital stay, increased recurrence of symptoms and increased reintervention rate, while quality of life and survival could not be analyzed due to insufficient adequate-quality data 1 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis

et al. 2022

View full text Add to dashboard Cite

Background and study aims Malignant disease accounts for up to 80 % of gastric outlet obstruction (GOO) cases, which may be treated with duodenal self-expanding metal stents (SEMS), surgical gastrojejunostomy (GJ), and more recently endoscopic-ultrasound-guided gastroenterostomy (EUS-GE). These three treatments have not been compared head-to-head in a randomized trial. Methods We searched the Embase and MEDLINE databases for studies published January 2015−February 2021 assessing treatment of malignant GOO using duodenal SEMS, endoscopic (EUS-GE) or surgical (laparoscopic or open) GJ. Efficacy outcomes assessed included technical and clinical success rates, GOO recurrence and reintervention. Safety outcomes included procedure-related bleeding or perforation, and stent-related events for the duodenal SEMS and EUS-GE arms. Results EUS-GE had a lower rate of technical success (95.3%) than duodenal SEMS (99.4 %) or surgical GJ (99.9%) (P = 0.0048). For duodenal SEMS vs. EUS-GE vs. surgical GJ, rates of clinical success (88.9 % vs. 89.0 % vs. 92.3 % respectively, P = 0.49) were similar. EUS-GE had a lower rate of GOO recurrence based on limited data (P = 0.0036), while duodenal SEMS had a higher rate of reintervention (P = 0.041). Overall procedural complications were similar (duodenal SEMS 18.7 % vs. EUS-GE 21.9 % vs. surgical GJ 23.8 %, P = 0.32), but estimated bleeding rate was lowest (P = 0.0048) and stent occlusion rate was highest (P = 0.0002) for duodenal SEMS. Conclusions Duodenal SEMS, EUS-GE, and surgical GJ showed similar clinical efficacy for the treatment of malignant GOO. Duodenal SEMS had a lower procedure-related bleeding rate but higher rate of reintervention.

show abstract

Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction

Upchurch

Ragusa

Cirocchi

2018

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

The use of duodenal stent placement in malignant gastric outlet obstruction has the benefits of a quicker resumption of oral intake and a reduced inpatient hospital stay; however, this is balanced by an increase in the recurrence of symptoms and the need for further intervention.It is impossible to draw further conclusions on these and the other measured outcomes, primarily due to the low number of eligible studies and small number of participants which resulted in low-quality evidence. It was not possible to analyse the impact on quality of life each intervention had for these participants.

show abstract

Stent placement versus surgical palliation for malignant gastric outlet obstruction

Cited by 5 publications

References 23 publications

Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis

Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction

Contact Info

Product

Resources

About