Skip to main content
SpringerLink
Log in

Treatment of malignant gastric outlet obstruction: endoscopic implantation of self-expanding metal stents versus gastric bypass surgery

Therapie der malignen Magenausgangsstenose: Endoskopischer Metall-Stent versus Gastroenteroanastomose

  • Original Scientific Paper
  • Published:
European Surgery Aims and scope Submit manuscript

Zusammenfassung

GRUNDLAGEN: Zur palliativen Therapie einer malignen Magenausgangsstenose wird bis heute meistens eine Gastroenterostomie angelegt. Dieser Eingriff hat aber eine signifikante Morbiditäts- und Mortalitätsrate und ist häufig mit einer Magenentleerungstörung assoziiert. Die endoskopische Stentimplantation zur symptomatischen Therapie einer malignen Magenausgangsstenose ist dagegen ein wenig invasiver Eingriff. In dieser Studie wird die endoskopische Stentimplantation mit der operativen Anlage einer Gastroenterostomie verglichen. METHODIK: In dieser Studie werden 22 Patienten nach endoskopischer Stentimplantation, mit 17 Patienten nach Anlage einer Gastroenterostomie, zur symptomatischen Therapie einer malignen Magenausgangsstenose, verglichen. Die Patienten sind während des gleichen Zeitraumes behandelt worden. ERGEBNISSE: Die Obstruktionssymptomatik konnte bei allen 22 Patienten durch die endoskopische Stentimplantation gebessert werden (100%). Im Vergleich dazu kam es nur bei 11 von 17 Patienten zu einer Besserung der Obstruktionssymptomatik nach operativer Anlage einer Gastroenterostomie (64,5%). Die "Stentpatienten" hatten einen kürzeren Spitalsaufenthalt (4 Tage vs. 13 Tage), konnten früher oral ernährt werden (1 vs. 6 Tage), hatten geringere Spitalskosten (€ 2143 vs. € 6617) und keine eingriffsbedingte Mortalität (0/22 vs. 3/17). Die Unterschiede bezüglich Spitalsaufenthaltsdauer, Verbesserung der Obstruktionssymptomatik, Nahrungskarenz und Spitalskosten sind statistisch signifikant (p < 0,05). SCHLUSSFOLGERUNGEN: Die endoskopische Stentimplantation zur palliativen Therapie der malignen Magenausgangsstenose ist hoch effizient, sehr sicher und kostengünstig. Sie sollte das Verfahren der Wahl zur Palliation einer malignen Magenausgangsstenose sein.

Summary

BACKGROUND: Palliative gastroenteric bypass surgery, the mainstay in the treatment of gastric outlet obstruction, has several disadvantages, including significant morbidity and mortality rates, and is frequently associated with delayed gastric emptying. Endoscopic stenting is reported to be an efficient and less invasive procedure for the symptomatic treatment of malignant GI tract obstruction. This study compares the outcomes of gastroenteric bypass surgery and endoscopic stenting. METHODS: We retrospectively analyzed 22 patients who underwent palliative endoscopic stenting of malignant gastric outlet obstruction or malignant obstruction in the upper part of the jejunum and compared them with 17 patients treated with palliative gastric bypass surgery during the same period. RESULTS: Obstructive symptoms improved in all 22 patients (100%) after endoscopic stenting compared to 11 of 17 patients (64.5%) after palliative gastric bypass surgery. The stent patients had a shorter hospital stay (4 days vs. 13 days), tolerated oral nutrition earlier (1 day vs. 6 days), had lower costs for hospital treatment (€ 2143 vs. € 6617) and had no procedure-related mortality after stent implantation (0/22 vs. 3/17). The differences in hospital stay, in improvement of symptoms, in time until resumption of oral nutrition and in hospital charges were statistically significant (p < 0.05). CONCLUSIONS: Endoscopic stent implantation, as palliative treatment for malignant gastric outlet obstruction or malignant stenosis in the upper part of the jejunum, is a highly effective, extremely safe and cost-efficient method. It should be the first choice in the treatment of malignant obstruction in this part of the GI tract.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  • Song HY, Do YS, Han YM, Sung KB, Choi EK, Sohn KH, Kim HR, Kim SH, Min YI (1994) Covered, expandable esophageal metallic stent tubes: experiences in 119 patients. Radiology 193: 689–695

    PubMed  CAS  Google Scholar 

  • Song HY, Yang DH, Kuh JH, Choi KC (1993) Obstructing cancer of the gastric antrum: palliative treatment with covered metallic stents. Radiology 187: 357–358

    PubMed  CAS  Google Scholar 

  • Rossi P, Bezzi M, Rossi M, Adam A, Chetty N, Roddie ME, Iacari V, Cwikiel W, Zollikofer CL, Antonucci F, et al (1994) Metallic stents in malignant biliary obstruction: results of a multicenter European study of 240 patients. J Vasc Interv Radiol 5: 279–285

    PubMed  CAS  Google Scholar 

  • el-Shabrawi A, Cerwenka H, Bacher H, Schweiger J, Kornprat P, Mischinger HJ (2003) [Endoscopic palliation of malignant gastric outlet obstruction by self-expanding metal stents]. Wien Klin Wochenschr 115: 840–845

    Article  PubMed  Google Scholar 

  • Klingler A (2004) Statistical methods in surgical research – a practical guide. Eur Surg 36: 80–84

    Article  Google Scholar 

  • Baron TH, Schofl R, Puespoek A, Sakai Y (2001) Expandable metal stent placement for gastric outlet obstruction. Endoscopy 33: 623–628

    PubMed  CAS  Google Scholar 

  • de Rooij PD, Rogatko A, Brennan MF (1991) Evaluation of palliative surgical procedures in unresectable pancreatic cancer. Br J Surg 78: 1053–1058

    PubMed  CAS  Google Scholar 

  • Weaver DW, Wiencek RG, Bouwman DL, Walt AJ (1987) Gastrojejunostomy: is it helpful for patients with pancreatic cancer? Surgery 102: 608–613

    PubMed  CAS  Google Scholar 

  • Lillemoe KD, Cameron JL, Hardacre JM, Sohn TA, Sauter PK, Coleman J, Pitt HA, Yeo CJ (1999) Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 230: 322–328; discussion 328–330

    Article  PubMed  CAS  Google Scholar 

  • van Wagensveld BA, Coene PP, van Gulik TM, Rauws EA, Obertop H, Gouma DJ (1997) Outcome of palliative biliary and gastric bypass surgery for pancreatic head carcinoma in 126 patients. Br J Surg 84: 1402–1406

    Article  PubMed  CAS  Google Scholar 

  • Hartgrink HH, Putter H, Klein Kranenbarg E, Bonenkamp JJ, van de Velde CJ; Dutch Gastric Cancer Group (2002) Value of palliative resection in gastric cancer. Br J Surg 89: 1438–1443

    Article  PubMed  CAS  Google Scholar 

  • Choi YB (2002) Laparoscopic gastrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer. Surg Endosc 16: 1620–1626

    Article  PubMed  Google Scholar 

  • Bergamaschi R, Marvik R, Thoresen JE, Ystgaard B, Johnsen G, Myrvold HE (1998) Open versus laparoscopic gastrojejunostomy for palliation in advanced pancreatic cancer. Surg Laparosc Endosc 8: 92–96

    Article  PubMed  CAS  Google Scholar 

  • Kuriansky J, Saenz A, Astudillo E, Cardona V, Fernandez-Cruz L (2000) Simultaneous laparoscopic biliary and retrocolic gastric bypass in patients with unresectable carcinoma of the pancreas. Surg Endosc 14: 179–181

    Article  PubMed  CAS  Google Scholar 

  • Popiela T, Kedra B, Sierzega M, Kubisz A (2002) [Surgical palliation for pancreatic cancer. The 25-year experience of a single reference centre]. Zentralbl Chir 127: 965–970

    Article  PubMed  CAS  Google Scholar 

  • Fujino Y, Suzuki Y, Kamigaki T, Mitsutsuji M, Kuroda Y (2001) Evaluation of gastroenteric bypass for unresectable pancreatic cancer. Hepatogastroenterology 48: 563–568

    PubMed  CAS  Google Scholar 

  • McLean GK, Cooper GS, Hartz WH, Burke DR, Meranze SG (1987) Radiologically guided balloon dilation of gastrointestinal strictures. Part I. Technique and factors influencing procedural success. Radiology 165: 35–40

    PubMed  CAS  Google Scholar 

  • McLean GK, Cooper GS, Hartz WH, Burke DR, Meranze SG (1987) Radiologically guided balloon dilation of gastrointestinal strictures. Part II. Results of long-term follow-up. Radiology 165: 41–43

    PubMed  CAS  Google Scholar 

  • Mischinger HJ, Hauser H, Cerwenka H, Stucklschweiger G, Geyer E, Schweiger W, Rosanelli G, Kohek PH, Werkgartner G, Hackl A (1997) Endocavitary Ir-192 radiation and laser treatment for palliation of obstructive rectal cancer. Eur J Surg Oncol 23: 428–431

    Article  PubMed  CAS  Google Scholar 

  • Truong S, Bohndorf V, Geller H, Schumpelick V, Gunther RW (1992) Self-expanding metal stents for palliation of malignant gastric outlet obstruction. Endoscopy 24: 433–435

    Article  PubMed  CAS  Google Scholar 

  • Nassif T, Prat F, Meduri B, Fritsch J, Choury AD, Dumont JL, Auroux J, Desaint B, Boboc B, Ponsot P, Cervoni JP (2003) Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study. Endoscopy 35: 483–489

    Article  PubMed  CAS  Google Scholar 

  • Maetani I, Inoue H, Sato M, Ohashi S, Igarashi Y, Sakai Y (1996) Peroral insertion techniques of self-expanding metal stents for malignant gastric outlet and duodenal stenoses. Gastrointest Endosc 44: 468–471

    Article  PubMed  CAS  Google Scholar 

  • Zollikofer CL, Jost R, Schoch E, Decurtins M (2000) Gastrointestinal stenting. Eur Radiol 10: 329–341

    Article  PubMed  CAS  Google Scholar 

  • 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: 72–78

    Article  PubMed  Google Scholar 

  • Maetani I, Tada T, Ukita T, Inoue H, Sakai Y, Nagao J (2004) Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 36: 73–78

    Article  PubMed  CAS  Google Scholar 

  • Wong YT, Wong YT, Brams DM, Munson L, Sanders L, Heiss F, Chase M, Birkett DH, et al (2002) Gastric outlet obstruction secondary to pancreatic cancer: surgical vs endoscopic palliation. Surg Endosc 16: 310–312

    Article  PubMed  CAS  Google Scholar 

  • Yim HB, Jacobson BC, Saltzman JR, Johannes RS, Bounds BC, Lee JH, Shields SJ, Ruymann FW, Van Dam J, Carr-Locke DL (2001) Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 53: 329–332

    PubMed  CAS  Google Scholar 

  • Mittal A, Windsor J, Woodfield J, Casey P, Lane M (2004) Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 91: 205–209

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Medical University of Graz, Graz, Austria

    A. El-Shabrawi, H. Cerwenka, H. Bacher, P. Kornprat, J. Schweiger & H.-J. Mischinger

Authors
  1. A. El-Shabrawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Cerwenka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Bacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Kornprat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Schweiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H.-J. Mischinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. El-Shabrawi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Shabrawi, A., Cerwenka, H., Bacher, H. et al. Treatment of malignant gastric outlet obstruction: endoscopic implantation of self-expanding metal stents versus gastric bypass surgery. Eur Surg 38, 451–455 (2006). https://doi.org/10.1007/s10353-006-0295-z

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10353-006-0295-z

Schlüsselwörter

Keywords

Search

Navigation