Abstract
Background: Endoscopic enteral stents have emerged as reasonable alternatives to palliative surgery in malignant intestinal obstruction. There is an extensive outcome experience with endoscopic stenting of malignant esophageal obstruction but little information about endoscopic stenting of other gastrointestinal sites. We report our experience with enteral stents for malignant non-esophageal obstruction. Methods: Data of all patients who had undergone enteral stenting at our institution between April 96 to Oct 99, entered into a prospective database, were reviewed. Results: Twenty-nine patients with a mean age of 67.7 years (33 to 87 years) were studied. Thirteen (45%) were male and 16 (55%) female. The diagnoses were gastric (16.1%), duodenal (9.7%), pancreatic (38.7%), metastatic (25.8%) and other (3.2%) malignancies. Malignant obstruction occurred at the pylorus (25.8%), 1 st part of duodenum (35.5%), 2 nd part of duodenum (25.8%), 3 rd part of duodenum (3.2%), colon (3.2%) and anastomotic sites (6.5%). Enteral Wallstents (Boston Scientific Microvasive, Natick, MA) of length 90 or 60 mm with diameter 22mm were used in all patients. Twenty-seven (94%) of the procedures were successful with good clinical outcome. Of the two failures (6%), one had malposition of the stent while the other had a severe obstruction which did not permit passage of a guidewire. Two had re-obstruction by tumor ingrowth after a mean stent survival time of 197 days and were successfully palliated by deploying a second stent within the original obstructed stent. There were no complications attributed to enteral stenting but one death occurred after one day in a patient with multiple organ failure. Of the 29 patients, 12 have died with a median survival time of 44 days. Conclusion: Endoscopic enteral stenting of non-esophageal malignant obstruction is a safe procedure with good clinical outcome as stent patency is likely to outlast the patient s survival.
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