Elsevier

Gastrointestinal Endoscopy

Volume 60, Issue 6, December 2004, Pages 916-920
Gastrointestinal Endoscopy

Original Article
Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study

https://doi.org/10.1016/S0016-5107(04)02228-XGet rights and content

Background

Endoscopic placement of self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction is safe and feasible.

Methods

Patients with malignant gastric outlet obstruction undergoing enteral stent insertion were identified from endoscopy databases. Duration of oral intake after stent insertion was calculated by using the log-rank test. Factors associated with duration of oral intake were assessed by using Cox multivariable regression analysis.

Results

A total of 176 patients (mean age 65 [14] years) treated at 4 centers from 1996 to 2003 were identified. Obstruction was caused by cancer of the pancreas in 84, the stomach in 20, the bile duct in 15, the major duodenal papilla in 8, another primary site in 16, and metastases in 33. The site of obstruction was the duodenum in 125, the distal stomach in 17, the stomach and the duodenum in 18, and surgical anastomosis in 16 patients. Stent deployment was technically successful in 173. Complications occurred in 14 patients. Seventeen patients were lost to follow-up. Of the remaining 159 patients, 133 resumed oral intake for a median time of 146 days: 95% CI [65, 202]. On regression analysis, chemotherapy after stent placement was associated with prolonged duration of oral intake (hazard ratio 0.41: 95% CI [0.23, 0.72]).

Conclusions

After enteral stent insertion for malignant gastric outlet obstruction, 84% of patients resumed oral intake for a median time of 146 days. Chemotherapy after enteral stent insertion was independently associated with prolongation of oral intake.

Section snippets

Patients and methods

A cohort of patients who had undergone enteral stent placement for malignant gastric outlet obstruction was constructed from patients seen at 4 endoscopic referral centers: Brigham and Women's Hospital, Boston, Massachusetts (1993-2003), Mayo Clinic, Rochester, Minnesota (1998-2002), Catholic University, Rome, Italy (1996-2002), and Northwestern University, Chicago, Illinois (1999-2002). Twenty-nine of 68 patients from the Brigham and Women's Hospital and 35 of 43 patients from the Mayo Clinic

Results

A total of 176 patients (56% men, mean age 65 [14] years) meeting the inclusion criteria were identified at the 4 sites. Obstruction was caused by pancreatic cancer in 84 (48%) patients, metastases in 33 (19%), gastric cancer in 20 (11%), cholangiocarcinoma in 15 (8%), cancer of the papilla in 8 (5%), gallbladder cancer in 4 (2%), and another type of malignancy in 12 (7%). The site of obstruction was the duodenum in 125 (71%), the distal stomach in 17 (10%), both the stomach and the duodenum in

Discussion

The ability of a patient to eat is determined by appetite and the functional status of the GI tract. Appetite is affected by mood, symptoms, functional status, and tumor burden.15 Normal motility is required for the GI tract to function. Motility is affected by peritoneal carcinomatosis, long-standing obstruction, and patency. Although many factors other than enteral stent obstruction may cause or contribute to cessation of oral intake in the patient population with malignant disease, oral

References (17)

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This work was presented in part at the annual meeting of the American Society of Gastrointestinal Endoscopy, May 18-21, 2003, Orlando, Florida (Gastrointest Endosc 2003;57:AB116).

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