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Enteral Stents are Safe and Effective to Relieve Malignant Gastric Outlet Obstruction in the Elderly

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Abstract

Background

Nausea, vomiting and intolerance to oral intake are usually the first presenting symptoms of gastric outlet obstruction, which not only cause malnutrition and increases chances of aspiration pneumonia but also greatly impair the quality of life. Self expandable metallic stents (SEMS) are both effective and safe to relieve the distressing symptoms of gastric outlet obstruction. The aim of this study was to compare the outcomes of endoscopic enteral stent insertion in malignant gastric outlet obstruction in older versus younger patients.

Methods

Eighty two patients were identified to have undergone SEMs insertion for malignant gastric outlet obstruction. Of these, 26 were ≥65 years (older patient group) and 56 were ≤65 years (younger patient group). These were retrospectively reviewed to assess the success rate and the complications of the procedure.

Results

Both groups were comparable in terms of technical success (100 % in older patient group versus 97 % in younger patient group). Clinical success rate, as determined by gastric outlet obstruction scoring system score (GOOSS) was also similar in both groups. Additionally, the rate of complications in both groups was also comparable, 27 % in older patient versus 23 % in younger patients (p = 0.085).

Conclusion

Enteral stenting for malignant gastric outlet obstruction is effective in the older patient groups with its success rate and complications comparable to younger patient population.

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References

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

    Article  CAS  PubMed  Google Scholar 

  2. Jung GS, Song HY, Kang SG, Huh JD, Park SJ, Koo JY, et al. Malignant gastroduodenal obstruction: treatment by means of a covered expandable metallic stent-initial experience. Radiology. 2000;216:758–63.

    Article  CAS  PubMed  Google Scholar 

  3. Bessoud B, de Baere T, Denys A, Kouch V, Ducreux M, Precetti S, et al. Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents. J Vasc Interv Radiol. 2005;16:247–53.

    Article  PubMed  Google Scholar 

  4. Tada M, Nakai Y, Sasaki T, Hamada T, Nagano R, Mohvi D, et al. Recent progress and limitations of chemotherapy for pancreatic and biliary tract cancers. World J Clin Oncol. 2011;2:158–63.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, et al. S-1 plus cisplatin versus S-1 alone for first time treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9:215–21.

    Article  CAS  PubMed  Google Scholar 

  6. Nakai Y, Isayama H, Sasaki T, Sasahira N, Ito Y, Kogure H, et al. Impact of S-1 on the survival of patients with advanced pancreatic cancer. Pancreas. 2010;39:989–93.

    Article  CAS  PubMed  Google Scholar 

  7. Sasaki T, Isayama H, Nakai Y, Ito Y, Kogure H, Togawa O, et al. Multicenter, phase II study of gemcitabine and S-1 combination chemotherapy in patients with advanced biliary tract cancer. Cancer Chemother Pharmacol. 2010;65:1101–7.

    Article  CAS  PubMed  Google Scholar 

  8. Sasaki T, Isayama H, Nakai Y, Mizuno S, Yamamoto K, Yagioka H, et al. Multicenter phase II study of S-1 monotherapy as second line chemotherapy for advanced biliary tract cancer refractory to gemcitabine. Invest New Drugs. 2012;30:708–13.

    Article  CAS  PubMed  Google Scholar 

  9. Maetanni I, Akatsuka S, Ikeda M, Tada T, Ukita T, Nakamura Y, et al. Self expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy. J Gastroenterol. 2005;40:932–7.

    Article  Google Scholar 

  10. Hosono S, Ohtani H, Arimoto Y, Kanamiya Y. Endoscopic stenting vs. surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol. 2007;42:283–90.

    Article  PubMed  Google Scholar 

  11. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.

    Article  CAS  PubMed  Google Scholar 

  12. Piesman M, Kozarek RA, Brandabur JJ, Pleskow DK, Chuttani R, Eysselein VE. Improved oral intake after palliative duodenal stenting for malignant obstruction. A prospective multicenter clinical trial. Am J Gastroenterol. 2009;104:2404–11.

    Article  PubMed  Google Scholar 

  13. van Hooft J, Mutignani M, Repici A, Messmann H, Neuhaus H. First data on the palliative treatment of patients with malignant gastric outlet obstruction using the WallFlex enteral stent: a retrospective multicenter study. Endoscopy. 2007;39:434–9.

    Article  PubMed  Google Scholar 

  14. Lee SR, Kim HO, Yoo CH. Impact of chronological age in the elderly with gastric cancer. J Korean Surg Soc. 2012;82:211–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Hanada K, Hino F, Amano H, Fukuda T, Kuroda Y. Current treatment strategies for pancreatic cancer in the elderly. Drugs Aging. 2006;23:403–10.

    Article  PubMed  Google Scholar 

  16. Watanapa P, Williamson RC. Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg. 1992;79:8–20.

    Article  CAS  PubMed  Google Scholar 

  17. Dormann AJ. Endoscopic palliation and nutritional support in advanced gastric cancer. Dig Dis. 2004;22:351–9.

    Article  CAS  PubMed  Google Scholar 

  18. Tierney W, Chuttani R, Croffie J, DiSairo J, Liu J, Mishkin DS, et al. Enteral stent. Gastrointest Endosc. 2006;63:920–6.

    Article  PubMed  Google Scholar 

  19. Fiori E, Lamazza A, Volpino P, Burza A, Paparelli C, Cavallaro G. Palliative management of malignant antro-pyloric strictures: gastroenterostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res. 2004;24:269–71.

    PubMed  Google Scholar 

  20. Mehta S, Hindmarsh A, Cheong E, Cockburn J, Saada J, Tighe R. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc. 2006;20:239–42.

    Article  CAS  PubMed  Google Scholar 

  21. Froehlich F, Gonvers JJ, Vader JP, Dubois RW, Burnand B. Appropriateness of gastrointestinal endoscopy: risk of complications. Endoscopy. 1999;31:684–6.

    Article  CAS  PubMed  Google Scholar 

  22. Mansoor H, Yusuf MA. Outcomes of endoscopic pyloric stenting in malignant gastric outlet obstruction: a retrospective study. BMC Res Notes. 2013;6:280.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Yk C, Kim SW, Hur WH, Nam KW, Chang JH, Park JM, et al. Clinical outcomes of self-expandable metal stent and prognostic factors for stent patency in gastric obstruction caused by gastric cancer. Dig Dis Sci. 2010;55:668–74.

    Article  Google Scholar 

  24. van Hooft JE, Uitdehaag MJ, Bruno M, Timmer R, Siersema PD, Dijkgraf MG, et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study):a prospective multicenter study. Gastrointest Endosc. 2009;69:1059–66.

    Article  PubMed  Google Scholar 

  25. Cha BH, Lee SH, Kim JE, Yoo JY, Park YS, Kim JW, et al. Endoscopic self-expandable metallic stent placement in malignant pyloric or duodenal obstruction: does chemotherapy affect stent patency? Asia Pac J Clin Oncol. 2013;9:162–8.

    Article  PubMed  Google Scholar 

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Acknowledgments

We gratefully acknowledge the help of Dr. Waleed Zafar with statistical analyses.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of Interests

There were no financial or non-financial interests or funding involved in this study.

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Authors and Affiliations

  1. Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7/A Block R-3, MA Johar Town, Lahore, Pakistan, 5400

    Hala Mansoor & Faisal Zeb

Authors
  1. Hala Mansoor
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  2. Faisal Zeb
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Corresponding author

Correspondence to Hala Mansoor.

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Mansoor, H., Zeb, F. Enteral Stents are Safe and Effective to Relieve Malignant Gastric Outlet Obstruction in the Elderly. J Gastrointest Canc 46, 42–47 (2015). https://doi.org/10.1007/s12029-014-9675-y

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  • DOI: https://doi.org/10.1007/s12029-014-9675-y

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