Journal of Gastrointestinal Surgery

, Volume 12, Issue 11, pp 2045–2050 | Cite as

Enteral Stents for Malignancy: A Report of 46 Consecutive Cases over 10 years, with Critical Review of Complications

  • Melissa S. Phillips
  • Sonia Gosain
  • Hugo Bonatti
  • Charles M. Friel
  • Kristi Ellen
  • Patrick G. Northup
  • Michel KahalehEmail author
ssat poster presentation manuscript



Current management of malignant gastric outlet obstruction (GOO) includes surgical diversion or enteral stent placement for unresectable cancer. We analyzed the long-term results, predictive factors of outcomes, and complications associated with enteral stents with focus on their management.


Between 1997 and 2007, 46 patients with malignant GOO underwent placement of self-expandable metal stents (SEMS) for palliation. Patients were captured prospectively after 2001 and followed until complication or death. Patency, management of complications, and long-term survival were analyzed.


Forty-six patients had a mean survival of 152 ± 235 days and a mean SEMS patency rate of 111 ± 220 days. SEMS patency rates of 98%, 74%, and 57% at 1, 3, and 6 months were seen. Thirteen patients presented with obstruction and included two SEMS migration, two early occlusion, one fracture, four malignant ingrowth, and four with delayed clinical failure. Interventions included seven endoscopic revisions with three SEMS replacements. Six had percutaneous endoscopic gastrostomy with jejunal arm placed. Two patients eventually underwent surgical bypass. Two patients required surgery for complications including delayed duodenal perforation and aortoenteric fistula.


SEMS effectively palliate gastric outlet obstructions that result from upper gastrointestinal malignancies. Their benefits offset potential complications or malfunctions, when a pluridisciplinary approach is adopted.


Enteral stent Malignant gastric outlet obstruction Unresectable cancer Self-expandable metal stent 


  1. 1.
    Awan A, Johnston DE, Jamal MM. Gastric outlet obstruction with benign endoscopic biopsy should be further explored for malignancy. Gastrointest Endosc 1998;48(5):497–500.PubMedCrossRefGoogle Scholar
  2. 2.
    Fisher WE, Andersen DK, Bell RH Jr, Saluja AK, Brunicardi FC. Chapter 32: The Pancreas. Schwartz’s Principles of Surgery. Eighth edition, (October 14, 2004).Google Scholar
  3. 3.
    Medina-Franco H, Abarca-Pérez L, España-Gómez N, Salgado-Nesme N, Ortiz-López LJ, García-Alvarez MN. Morbidity-associated factors after gastrojejunostomy for malignant gastric outlet obstruction. Am Surg. 2007;73(9):871–875.PubMedGoogle Scholar
  4. 4.
    Graber I, Dumas R, Filoche B, Boyer J, Coumaros D, Lamouliatte H, Legoux JL, Napoleon B, Ponchon T, Societe Francaise d’Endoscopie Digestive. The efficacy and safety of duodenal stenting: a prospective multicenter study. Endoscopy 2007;39(9):784–787.PubMedCrossRefGoogle Scholar
  5. 5.
    Maetani I, Tada T, Ukita T et al. Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 2004;36:73–78.PubMedCrossRefGoogle Scholar
  6. 6.
    Johnsson E, Thune A, Liedman B. Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World J Surg 2004;28:812–817.PubMedCrossRefGoogle Scholar
  7. 7.
    Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol 2007;7:18.PubMedCrossRefGoogle Scholar
  8. 8.
    Espinel J, Sanz O, Vivas S, Jorquera F, Muñoz F, Olcoz JL, Pinedo E. Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation. Surg Endosc 2006;20(7):1083–1087.PubMedCrossRefGoogle Scholar
  9. 9.
    Singh SM, Longmire WP Jr, Reber HA. Surgical palliation for pancreatic cancer. The UCLA experience. Ann Surg 1990;212(2):132–139.PubMedCrossRefGoogle Scholar
  10. 10.
    Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 2001;344:1681–1687.PubMedCrossRefGoogle Scholar
  11. 11.
    Baron TH, Harewood GC. Enteral self-expandable stents. Gastrointest Endosc 2003;58:421–433.PubMedCrossRefGoogle Scholar
  12. 12.
    Dormann A, Meisner S, Verin N et al. Self expainding metal stents for gastroduodenal malignancies: systemic review of their clinical effectiveness. Endoscopy 2004;36:543–550.PubMedCrossRefGoogle Scholar
  13. 13.
    Mauro MA, Koecher RE, Baron TH. Advances in gastrointestinal intervention. The treatment of gastroduodenal and colorectal obstructions with metallic stents. Radiology 2000;215:659–669.PubMedGoogle Scholar
  14. 14.
    Graber L, Dumas R, Foliche B et al. The efficacy and safety of duodenal stenting: a prospective multicenter study. Endoscopy 2007;39:784–787.PubMedCrossRefGoogle Scholar
  15. 15.
    Beecherl EE, Shires GT, Shires GT. Treatment of Post-pancreaticoduodenectomy Complications. Curr Treat Options Gastroenterol 2004;7(5):365–370.PubMedCrossRefGoogle Scholar
  16. 16.
    Mittal A, Windsor J, Woodfield J et al. Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 2004;91:205–209.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Melissa S. Phillips
    • 1
  • Sonia Gosain
    • 2
  • Hugo Bonatti
    • 1
  • Charles M. Friel
    • 1
  • Kristi Ellen
    • 2
  • Patrick G. Northup
    • 2
  • Michel Kahaleh
    • 2
    Email author
  1. 1.SurgeryUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Digestive Health CenterUniversity of Virginia Health SystemCharlottesvilleUSA

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