The Palliative Effect of Endoscopic Uncovered Self-expandable Metallic Stent Placement Versus Gastrojejunostomy on Malignant Gastric Outlet Obstruction: A Pilot Study with a Retrospective Chart Review in Saga, Japan

Abstract

Objective Endoscopic self-expandable metallic stent (SEMS) placement and gastrojejunostomy (GJY) are palliative treatments for malignant gastric outlet obstruction (GOO). The aim of the present study was to compare the palliative effects of these treatments and identify predictors of a poor oral intake after treatment. Methods and Patients In total, 65 patients with GOO at multiple centers in Saga, Japan, were evaluated. Thirty-eight patients underwent SEMS placement, and 27 underwent GJY from January 2010 to December 2016. The characteristics and outcomes of the two groups were compared to detect predictors of treatment failure. Results No significant differences in the technical success, clinical success, post-treatment total protein, hospital discharge, duration from eating disability to death, or post-treatment overall survival were present between the SEMS and GJY groups. More patients in the GJY group than in the SEMS group received chemotherapy (51.4% vs. 26.3%, respectively; p=0.042). The period from treatment to the first meal was longer in the GJY group than in the SEMS group (4.5 vs. 3.0 days, respectively; p=0.013). The present study did not identify any risk factors for failure of SEMS placement. Although the stent length tended to be associated with a poor prognosis, the correlation was not statistically significant (odds ratio: 0.60, 95% confidence interval: 0.36-1.01, p=0.053). Conclusion Patients with GOO started meals more promptly after SEMS than after GJY, but the clinical outcomes were not markedly different between the SEMS and GJY groups. These findings suggest that endoscopic uncovered SEMS placement might be a feasible palliative treatment for GOO.

Renal pelvis cancer with initial symptoms of malignant gastric outlet obstruction

“…Palliative options for MGOO include Gastrojejunostomy and duodenal stenting. In a previous study, the median survival period for Gastrojejunostomy in cases of gastric and pancreatic malignancy‐induced MGOO was 129.0 days (IQR: 66.8–302.0), and for duodenal stenting, it was 79.0 days (IQR: 42.5–196.0) 18 . In our case, gastrojejunostomy was chosen, because we thought an intraoperative biopsy could be taken to reveal the cause of the duodenal stenosis.…”

Endoscopic Gastrointestinal Anastomosis Using Lumen-apposing Metal Stent (LAMS) for Benign or Malignant Etiologies

“…LAMS is a "dumbbell"-shaped metal stent that is partially covered allowing lumen apposition with its wide distal and proximal circumferential flanges with a reduced migration risk. 1,2 This technique may be used to bypass benign or malignant gastrointestinal (GI) strictures or alter the anatomic challenges introduced through bariatric surgeries, such as Roux-en-Y-gastric bypass (RYGB). Thus, an anatomic detour is provided for the flow of GI contents and endoscopic access to organs that have been excluded by GI altering surgeries.…”

“…LAMS were initially designed for endoscopic cystogastrostomy. LAMS is a “dumbbell”-shaped metal stent that is partially covered allowing lumen apposition with its wide distal and proximal circumferential flanges with a reduced migration risk 1,2. This technique may be used to bypass benign or malignant gastrointestinal (GI) strictures or alter the anatomic challenges introduced through bariatric surgeries, such as Roux-en-Y-gastric bypass (RYGB).…”

Gastric outlet obstruction caused by metastatic tumor of the stomach originating from primary breast cancer: A case report

“…Patients with malignant GOO tend to develop undesirable clinical symptoms that are detrimental to the quality of life of the patients, such as nausea, vomiting, abdominal pain and difficulty eating (9). Fluoroscopic or/and endoscopic SEMS placement as palliative treatment for malignant GOO is generally safe, easily performed and effective, and is associated with higher clinical success rates and lower morbidity and mortality rates compared with palliative surgery (9,10).…”