What is the ideal stent as initial intervention for malignant gastric outlet obstruction?

Park, Chan Ik; Kim, Joo Hang; Lee, Yong Chan; Jahng, Jun Seop; Youn, Young Hoon; Park, Hyojin; Lee, Sang In

doi:10.1016/j.dld.2012.08.021

Cited by 22 publications

(29 citation statements)

References 19 publications

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“…26 Moreover, stent patency rates were reported to be significantly improved when the SEMS was combined with subsequent chemotherapy. 7 This study had several limitations, including its retrospective observational design, with a small number of patients. In addition, the study lacked a control group for comparison.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 However, the main disadvantage of uncovered SEMSs is repeat stenosis because of tumor ingrowth. 1,6,7 Although a covered SEMS may solve the problem of tumor ingrowth, stent migration remains a problem requiring reintervention. 1,[6][7][8] To overcome the disadvantages of uncovered and covered SEMSs, partially covered duodenal stents (PCDSs), consisting of uncovered distal ends to prevent migration and an inner covered stent to prevent tumor ingrowth, have been developed.…”

mentioning

confidence: 99%

“…1,[6][7][8] To overcome the disadvantages of uncovered and covered SEMSs, partially covered duodenal stents (PCDSs), consisting of uncovered distal ends to prevent migration and an inner covered stent to prevent tumor ingrowth, have been developed. 7,9 This study was designed to investigate the technical and clinical efficacy and safety of the placement of PCDSs for malignant gastroduodenal obstruction.…”

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confidence: 99%

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Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction: a pilot study

Lee

Song

et al. 2015

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction: a pilot study

Lee

Song

et al. 2015

Gastrointestinal Endoscopy

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“…Uncovered SEMS presents higher obstruction rates because of tumor ingrowth through the mesh. Covered SEMS present lower obstruction, but higher migration rates 14.…”

Section: Introductionmentioning

confidence: 96%

Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review

et al. 2016

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Background and study aims: Palliative treatment of gastric outlet obstruction can be done with surgical or endoscopic techniques. This systematic review aims to compare surgery and covered and uncovered stent treatments for gastric outlet obstruction (GOO). Patients and methods: Randomized clinical trials were identified in MEDLINE, Embase, Cochrane, LILACs, BVS, SCOPUS and CINAHL databases. Comparison of covered and uncovered stents included: technical success, clinical success, complications, obstruction, migration, bleeding, perforation, stent fracture and reintervention. The outcomes used to compare surgery and stents were technical success, complications, and reintervention. Patency rate could not be included because of lack of uniformity of the extracted data. Results: Eight studies were selected, 3 comparing surgery and stents and 5 comparing covered and uncovered stents.The meta-analysis of surgical and endoscopic stent treatment showed no difference in the technical success and overall number of complications. Stents had higher reintervention rates than surgery (RD: 0.26, 95 % CI [0.05, 0.47], NNH: 4). There is no significant difference in technical success, clinical success, complications, stent fractures, perforation, bleeding and the need for reintervention in the analyses of covered and uncovered stents. There is a higher migration rate in the covered stent therapy compared to uncovered self-expanding metallic stents (SEMS) in the palliation of malignant GOO (RD: 0.09, 95 % CI [0.04, 0.14], NNH: 11). Nevertheless, covered stents had lower obstruction rates (RD: – 0.21, 95 % CI [-0.27, – 0.15], NNT: 5). Conclusions: In the palliation of malignant GOO, covered SEMS had higher migration and lower obstruction rates when compared with uncovered stents. Surgery is associated with lower reintervention rates than stents.

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“…Covered stents reduce the risk of tumor ingrowth; however, they have higher risks of stent migration (17,18,20). Recent studies comparing uncovered and covered SEMS in malignant GDO showed that the rates of reintervention due to stent dysfunction were similar between two stent groups (18,21,22). In case of stent dysfunction, additional coaxial stenting has been shown to enable oral intake (9,10).…”

Section: Discussionmentioning

confidence: 99%

Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

Bulut¹,

Çiftçi²,

Akhan³

et al. 2017

Diagn Interv Radiol

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M alignant gastroduodenal obstruction (GDO) is a common and debilitating complication of advanced gastric, duodenal, and pancreatobiliary cancers. It can also be seen due to lymphoma and metastatic spread of other malignancies (1, 2). Patients classically present with abdominal pain, nausea, and vomiting with resulting malnutrition and weight loss (1-3). The majority of patients have a median survival of only 3-6 months (4, 5).Curative surgery is often not possible and palliative surgical procedures might have high complication rates with delayed postoperative gastric emptying and prolonged hospitalization (1,(5)(6)(7)(8).Fluoroscopic or endoscopic placement of covered and uncovered metallic stents has been commonly performed in the palliation of malignant GDO as an alternative to gastrojejunostomy (GJ) with high technical and clinical success and low complication rates (5). However, recurrent obstruction due to tumor ingrowth and stent migration is a drawback of uncovered and covered metallic stents.The purpose of this study is to evaluate safety and effectiveness of fluoroscopy-guided gastroduodenal metallic stent placement using different approaches such as transoral, transgastric, and transhepatic in 53 patients with malignant obstruction. Patients who underwent combined biliary and duodenal stenting were also assessed. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the safety and effectiveness of fluoroscopy-guided gastroduodenal metallic stent placement with different approaches in malignant obstruction. METHODSWe retrospectively assessed 53 patients (33 men and 20 women; mean age, 58.7±15 years) who underwent stent placement between February 2004 and April 2014. All patients had unresectable tumors. The most common causes of obstruction were gastric (38%) and pancreatic cancers (36%). Uncovered self-expandable metallic stents (SEMS) were placed under fluoroscopic guidance. In addition to transoral approach in 46 patients (86.7%), transgastric and transhepatic approaches were used in six patients (11.3%) and one patient (1.8%), respectively. Gastric outlet obstruction scoring system (GOOSS) was used to evaluate oral intake before and after stenting. Patients were followed until death or the end of the study. RESULTSTechnical and clinical success rates were 100% and 92%, respectively. The median stent patency was 76 days (range, 4-985 days). Mean preprocedural GOOSS score of 0.1 increased to postprocedural GOOSS score of 2.42 (P < 0.001). Afferent loop decompression was achieved in one symptomatic patient. Neither mortality nor major complications occurred due to stenting. Stent migration occurred in one patient (2%) and stent obstruction occurred in two patients (4%). Combined biliary and duodenal stenting were performed in 21 patients (40%). Post-stenting GOOSS scores were predictive of survival (P = 0.003). CONCLUSIONFluoroscopic metallic stent placement for palliation of malignant gastroduodenal obstruction is safe and effective with high technica...

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What is the ideal stent as initial intervention for malignant gastric outlet obstruction?

Cited by 22 publications

References 19 publications

Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction: a pilot study

Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction: a pilot study

Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review

Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

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