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An Assessment of Radiologically Inserted Transoral and Transgastric Gastroduodenal Stents to Treat Malignant Gastric Outlet Obstruction

  • Clinical Investigation
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Abstract

Introduction

Self-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist.

Methods

Patients were identified from a prospectively collected database held by one consultant radiologist. Data were retrieved from radiological reports, multidisciplinary team meetings, and the patients’ case notes. Univariate survival analysis was performed.

Results

Between December 2000 and January 2011, 100 patients (63 males, 37 females) had 110 gastroduodenal stenting procedures. Median age was 73 (range 39–89) years. SEMS were inserted transorally (n = 66) or transgastrically (n = 44). Site of obstruction was the stomach (n = 37), duodenum (n = 50), gastric pull-up (n = 10), or gastroenterostomy (n = 13). Seven patients required biliary stents. Technical success was 86.4 %: 83.3 % for transoral insertion, 90.9 % for transgastric insertion. Eleven patients developed complications. Median GOO severity score: 1 pre-stenting, 2 post-stenting (p = 0.0001). Median survival was 54 (range 1–624) days. Post-stenting GOO severity score was predictive of survival (p = 0.0001).

Conclusions

The technical success rate for insertion of palliative SEMS is high. Insertional technique can be tailored to the individual depending on the location of the tumor and whether it is possible to access the stomach percutaneously. Patients who have successful stenting and return to eating a soft/normal diet have a statistically significant increase in survival.

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References

  1. Gaidos JK, Draganov PV (2009) Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents. World J Gastroenterol 15(35):4365–4371

    Article  PubMed  Google Scholar 

  2. Keranen I, Udd M, Lepisto A, Halttunen J, Kylanpaa L (2010) Outcome for self-expandable metal stents in malignant gastroduodenal obstruction: single-center experience with 104 patients. Surg Endosc 24:891–896

    Article  Google Scholar 

  3. Mehta S, Hindmarsh A, Cheong E et al (2006) Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc 20(2):239–242

    Article  PubMed  CAS  Google Scholar 

  4. Akinci D, Akhan O, Ozkan F et al (2007) Palliation of malignant biliary and duodenal obstruction with combined metallic stenting. Cardiovasc Intervent Radiol 30(6):1173–1177

    Article  PubMed  Google Scholar 

  5. Aviv RI, Shyamalan G, Khan FH et al (2002) Use of stents in the palliative treatment of malignant gastric outlet and duodenal obstruction. Clin Radiol 57(7):587–592

    Article  PubMed  CAS  Google Scholar 

  6. Bessoud B, de Baere T, Denys A et al (2005) Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents. J Vasc Interv Radiol 16(2 Pt 1):247–253

    Article  PubMed  Google Scholar 

  7. D’Altorio RA, Kvamme P (1998) Palliation of obstructing gastric carcinoma with metal stents through a gastrostomy. Am J Gastroenterol 93(6):991–993

    Article  PubMed  Google Scholar 

  8. Jeong JY, Han JK, Kim AY et al (2002) Fluoroscopically guided placement of a covered self-expandable metallic stent for malignant antroduodenal obstructions: preliminary results in 18 patients. AJR Am J Roentgenol 178(4):847–852

    Article  PubMed  Google Scholar 

  9. Keymling M, Wagner HJ, Vakil N, Knyrim K (1993) Relief of malignant duodenal obstruction by percutaneous insertion of a metal stent. Gastrointest Endosc 39(3):439–441

    Article  PubMed  CAS  Google Scholar 

  10. Pinto IT (1997) Malignant gastric and duodenal stenosis: palliation by peroral implantation of a self-expanding metallic stent. Cardiovasc Intervent Radiol 20(6):431–434

    Article  PubMed  CAS  Google Scholar 

  11. Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97(1):72–78

    Article  PubMed  Google Scholar 

  12. Hosono S, Ohtani H, Arimoto Y, Kanamiya Y (2007) Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol 42(4):283–290

    Article  PubMed  Google Scholar 

  13. Piesman M, Kozarek RA, Brandabur JJ et al (2009) Improved oral intake after palliative duodenal stenting for malignant obstruction: a prospective multicenter clinical trial. Am J Gastroenterol 104(10):2404–2411

    Article  PubMed  Google Scholar 

  14. Kim JH, Song HY, Shin JH et al (2009) Metallic stent placement in the palliative treatment of malignant gastric outlet obstructions: primary gastric carcinoma versus pancreatic carcinoma. AJR Am J Roentgenol 193(1):241–247

    Article  PubMed  Google Scholar 

  15. Kim JH, Song HY, Shin JH et al (2007) Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 66(2):256–264

    Article  PubMed  Google Scholar 

  16. de Baere T, Harry G, Ducreux M et al (1997) Self-expanding metallic stents as palliative treatment of malignant gastroduodenal stenosis. AJR Am J Roentgenol 169(4):1079–1083

    Article  PubMed  Google Scholar 

  17. Caldicott DG, Ziprin P, Morgan R (2000) Transhepatic insertion of a metallic stent for the relief of malignant afferent loop obstruction. Cardiovasc Intervent Radiol 23(2):138–140

    Article  PubMed  CAS  Google Scholar 

  18. Ozden I, Poyanli A, Kaygusuz A, Rozanes I, Alper A (2001) The transhepatic route for the placement of a duodenojejunal stent: application in a postoperative closed loop obstruction of the duodenum. Cardiovasc Intervent Radiol 24(1):70–71

    Article  PubMed  CAS  Google Scholar 

  19. Sabharwal T, Irani FG, Adam A (2007) Quality assurance guidelines for placement of gastroduodenal stents. Cardiovasc Intervent Radiol 30(1):1–5

    Article  PubMed  CAS  Google Scholar 

  20. Jang JK, Song HY, Kim JH, Song M, Park JH, Kim EY (2011) Tumor overgrowth after expandable metallic stent placement: experience in 583 patients with malignant gastroduodenal obstruction. AJR Am J Roentgenol 196(6):W831–W836

    Article  PubMed  Google Scholar 

  21. Tang T, Allison M, Dunkley I, Roberts P, Dickinson R (2003) Enteral stenting in 21 patients with malignant gastroduodenal obstruction. J R Soc Med 96(10):494–496

    Article  PubMed  Google Scholar 

  22. Larssen L, Medhus AW, Hauge T (2009) Treatment of malignant gastric outlet obstruction with stents: an evaluation of the reported variables for clinical outcome. BMC Gastroenterol 9:45

    Article  PubMed  Google Scholar 

  23. Razzaq R, Laasch HU, England R, Marriott A, Martin D (2001) Expandable metal stents for the palliation of malignant gastroduodenal obstruction. Cardiovasc Intervent Radiol 24(5):313–318

    Article  PubMed  CAS  Google Scholar 

  24. Pinto Pabon IT, Diaz LP, Ruiz De Adana JC, Lopez Herrero J (2001) Gastric and duodenal stents: follow-up and complications. Cardiovasc Intervent Radiol 24(3):147–153

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

Dr. Bethany H.T. Miller, Mr. Ewen A. Griffiths, Mr. Kishore G. Pursnani, Mr. Jeremy B. Ward, and Dr. Robert C. Stockwell have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK

    Bethany H. T. Miller, Kishore G. Pursnani & Jeremy B. Ward

  2. Department of Upper Gastrointestinal Surgery, The New Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK

    Ewen A. Griffiths

  3. Department of Radiology, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley and South Ribble Hospital, Chorley, PR7 1PP, UK

    Robert C. Stockwell

Authors
  1. Bethany H. T. Miller
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  2. Ewen A. Griffiths
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  3. Kishore G. Pursnani
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  4. Jeremy B. Ward
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  5. Robert C. Stockwell
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Correspondence to Robert C. Stockwell.

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Miller, B.H.T., Griffiths, E.A., Pursnani, K.G. et al. An Assessment of Radiologically Inserted Transoral and Transgastric Gastroduodenal Stents to Treat Malignant Gastric Outlet Obstruction. Cardiovasc Intervent Radiol 36, 1591–1601 (2013). https://doi.org/10.1007/s00270-013-0584-4

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  • DOI: https://doi.org/10.1007/s00270-013-0584-4

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