Palliative management of malignant gastric outlet obstruction with endoscopically inserted self-expanding metal stents

• Published in: Revista española de enfermedades digestivas Vol. 100; no. 6; pp. 320 - 326
• Main Authors: García-Cano, J, Sánchez-Manjavacas, N, Viñuelas Chicano, M, Jimeno Ayllón, C, Martínez Fernández, R, Gómez Ruiz, C J, Pérez García, J I, Redondo Cerezo, E, Morillas Ariño, M J, Pérez Vigara, M G, Pérez Sola, A
• Format: Journal Article
• Language: Spanish; English
• Published: Spain 01.06.2008
• Subjects: Aged; Aged, 80 and over; Female; Gastric Outlet Obstruction - etiology; Gastric Outlet Obstruction - surgery; Gastroscopy; Humans; Male; Middle Aged; Palliative Care - methods; Prosthesis Design; Retrospective Studies; Stents; Stomach Neoplasms - complications; Stomach Neoplasms - surgery
• ISSN: 1130-0108

the insertion of self-expanding metal stents to palliate malignant gastric outlet obstruction is a minimally invasive procedure that is being increasingly used. We discuss experience with this technique in a level-II hospital in the Spanish National Health System. a retrospective five-year study (2003-2007) was conducted in 23 patients who underwent 27 procedures aimed at resolving malignant gastric outlet obstruction (mean, 0.45 procedures per month) using endoscopically inserted noncovered stents (Wallstent and Wallflex). insertion was technically feasible in all 27 (100%) attempts, with satisfactory clinical results in 25 cases (92.5%). Endoscopy alone was used 10 times (37%), and both endoscopy and fluoroscopy on 17 (63%) occasions. After stent insertion, one patient was intervened for treatment, and a patient with an unsuccessful prosthesis received a palliative surgical bypass. Four stents became obstructed by tumoral ingrowth, and patency was reestablished by inserting a new stent. Obstructive jaundice caused by stents covering the papilla of Vater occurred in three cases. There were no other complications or mortality due to the procedure. Mean survival was 104 days (range 28-400, SD +/- 94). in our experience endoscopic insertion of self-expanding metal stents appears to be a safe and efficient palliative method for malignant gastric outlet obstruction, and can be performed successfully in a center with our characteristics.