Transjejunostomy Stent Placement in Patients With Malignant Small-Bowel Obstructions

Kim, Junwoo; Yoon, Chang Jin; Seong, Nak Jong

doi:10.2214/ajr.18.19599

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…The 57 observational studies 45 – 101 reported on the treatment of 12,587 patients, 92% of which were patients with malignant bowel obstruction. Of these palliative patients, 27% underwent surgery for their obstruction (initially or after temporary stenting) and 73% were inoperable.…”

Section: Resultsmentioning

confidence: 99%

“…Treatment-related preferences or goals of care expressed by study participants rather than clinicians were referred to in the descriptive text of 15% of studies. 34 , 48 , 50 – 52 , 59 , 66 , 68 , 69 , 72 , 85 , 86 …”

Section: Resultsmentioning

confidence: 99%

“…or weekly/monthly [22,27,42,85,91] (with follow-up to 24 weeks in studies evaluating decompressive procedures). Treatment-related preferences or goals of care expressed by study participants rather than clinicians were referred to in the descriptive text of 15% of studies [34,48,50,51,52,59,66,68,69,72,85,86] .…”

Section: Decompressive Interventions Pharmacological Interventionsmentioning

confidence: 99%

“…Treatment-related preferences or goals of care expressed by study participants rather than clinicians were referred to in the descriptive text of 15% of studies. 34,48,[50][51][52]59,66,68,69,72,85,86 Given that one of the aims of palliative care is to support patients achieve their preferred place of care, place of death (which does not appear elsewhere in the COMET taxonomy) was categorised under the life impact domain. This outcome appeared in 4% of studies 53,59,69 evaluating percutaneous decompression tube/gastrostomy procedures, two of these citing the procedure as facilitating home death.…”

Section: Symptomsmentioning

confidence: 99%

See 3 more Smart Citations

The range and suitability of outcome measures used in the assessment of palliative treatment for inoperable malignant bowel obstruction: A systematic review

et al. 2022

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Background: Malignant bowel obstruction, a complication of certain advanced cancers, causes severe symptoms which profoundly affect quality of life. Clinical management remains complex, and outcome assessment is inconsistent. Aim: To identify outcomes evaluating palliative treatment for inoperable malignant bowel obstruction, as part of a four-phase study developing a core outcome set. Design: The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); PROSPERO (ID: CRD42019150648). Eligible studies included at least one subgroup with obstruction below the ligament of Treitz undergoing palliative treatment for inoperable malignant bowel obstruction. Study quality was not assessed because the review does not evaluate efficacy. Data sources: Medline, Embase, the Cochrane Database, CINAHL, PSYCinfo Caresearch, Open Grey and BASE were searched for trials and observational studies in October 2021. Results: A total of 4769 studies were screened, 290 full texts retrieved and 80 (13,898 participants) included in a narrative synthesis; 343 outcomes were extracted verbatim and pooled into 90 unique terms across six domains: physiological, nutrition, life impact, resource use, mortality and survival. Prevalent outcomes included adverse events (78% of studies), survival (54%), symptom control (39%) and mortality (31%). Key individual symptoms assessed were vomiting (41% of studies), nausea (34%) and pain (33%); 19% of studies assessed quality of life. Conclusions: Assessment focuses on survival, complications and overall symptom control. There is a need for definitions of treatment ‘success’ that are meaningful to patients, a more consistent approach to symptom assessment, and greater consideration of how to measure wellbeing in this population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Decompressive Interventions Pharmacological Interventionsmentioning

confidence: 99%

Section: Symptomsmentioning

confidence: 99%

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The range and suitability of outcome measures used in the assessment of palliative treatment for inoperable malignant bowel obstruction: A systematic review

et al. 2022

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“…Stenting in jejuno-ileal obstructions is less common but has shown feasibility in limited series via percutaneous jejunostomy under IR guidance. 74 Although not mentioned explicitly in the pathway, experts in the consensus suggested the consideration for endoscopic lumen apposing metallic stent (LAMS)assisted gastro-jejunal or entero-enteric bypass for gastric outlet or more distal obstructions, respectively, as an alternative option for palliation. [75][76][77] The block version in round I lacked clarity regarding the selection of definitive surgical interventions and SEMS and yielded low consensus initially.…”

Section: Stentingmentioning

confidence: 99%

Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

Turaga

2024

Preprint

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Background: Malignant gastrointestinal obstruction (MGIO), a frequent complication of peritoneal surface malignancies (PSM), often portends a poor prognosis. The lack of high-quality evidence on optimal management strategies necessitated a national consensus to address this clinical problem. Methods: A clinical management pathway was designed through a Delphi consensus process with national experts in peritoneal disease. Two rounds of voting were conducted to assess agreement levels with pathway blocks. Supporting evidence regarding procedural interventions for MGIO underwent evaluation via a rapid literature review. Results: Of 111 participants responding in the first round, 90 (81%) responded in the second round. Over 90% consensus was achieved in 4/6 and 6/6 pathway blocks during rounds I and II, respectively. Encouraging a multidisciplinary approach, the pathway emphasized early palliative care assessments and iterative goals of care evaluation throughout treatment. Management was delineated based on obstruction acuity, and selection criteria for palliative-intent surgical interventions and stenting were elucidated. Studies demonstrated limited benefits for such interventions in patients with multifocal obstructions, poor performance status, and high-grade and/or high-burden PSMs. In these cases, a recommendation for supportive care or upper GI decompression tube placement was favored. The overall level of evidence was generally low-moderate in existing literature. Conclusion: Given limited evidence, the consensus-driven pathway provides crucial clinical guidance for practitioners dealing with MGIO in PSM patients. There is a need for high-quality prospective evidence in this domain.

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Recent Updates in Gastrointestinal Stent Placement from the Esophagus to the Colon: A Radiological Perspective

Kim

Shin

Zeng

et al. 2022

Cardiovasc Intervent Radiol

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Transjejunostomy Stent Placement in Patients With Malignant Small-Bowel Obstructions

Abstract: Transjejunostomy stent placement is an effective treatment in patients with malignant SBOs. It is technically feasible in most patients (95.7%) and provides substantial symptomatic improvement. Procedure-related complications are not rare but can be managed conservatively.

Cited by 5 publications

References 15 publications

The range and suitability of outcome measures used in the assessment of palliative treatment for inoperable malignant bowel obstruction: A systematic review

The range and suitability of outcome measures used in the assessment of palliative treatment for inoperable malignant bowel obstruction: A systematic review

Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

Recent Updates in Gastrointestinal Stent Placement from the Esophagus to the Colon: A Radiological Perspective

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