7153 Endoscopic palliation of malignant gastric-outlet obstruction.

Abstract

Introduction: Combined gastrojejunostomy and choledochoduodenostomy are routinely performed as treatment for malignant gastric-outlet obstruction. This procedure has significant morbidity and mortality and necessitates a considerable hospital stay.We describe a less invasive endoscopic treatments, with self-expanding metal stents. Patients and Methods: Three female patients, presenting with clinical findings of gastric outlet obstruction, confirmed by upper GI-endoscopy and/or upper GI X-ray, had endoscopic placement of expandable metal stents (Microvasive, 6 cm, 22 mm). In two patients , combined stenting of the duodenum and common bile duct was performed as a one step procedure. All patients had primary or metastatic malignancy involving the pylorus or duodenum. The mean age of the patients was 75 years. The first patient (71 years) had a breast carcinoma with metastasis in hilar lymph nodes, invading the common bile duct and subsequently causing gastric-outlet obstruction. The second patient (80 years) had a tumor in the head of the pancreas with liver metastasis, obstructive jaundice and secondary gastric-outlet obstruction. The third patient (74 years) had a cancer of the stomach, obstructing the pyloric region. No surgical procedure was performed because of the high age of the patients and the poor prognosis, suspected by the presence of metastatic disease. Results: Stent placement was successful in all patients. The procedure was followed by immediate clinical improvement, without complications. In case of a double endoscopic stenting procedure, transpyloric dilation was carried out, using a 18 mm balloon, in order to achieve access to the duodenum. After insertion of a biliary Wallstent, a guidewire was introduced in the third part of the duodenum. Subsequently, a Wallstent Enteral was released in the bulboduodenal region. All patients had excellent palliation with normal oral feeding within 24 to 48 hours. Two patients died after a mean of 7 weeks and could tolerate oral feeding well until 2-3 days before they died. The third patient is still alive after 6 weeks, without any complaint, and normal oral feeding so far. Conclusion: An endoscopically placed Wallstent provides effective palliation for malignant gastric-outlet obstruction. The procedure is easy to perform, non-invasive and well tolerated, with significant improvement in quality of live. Introduction: Combined gastrojejunostomy and choledochoduodenostomy are routinely performed as treatment for malignant gastric-outlet obstruction. This procedure has significant morbidity and mortality and necessitates a considerable hospital stay.We describe a less invasive endoscopic treatments, with self-expanding metal stents. Patients and Methods: Three female patients, presenting with clinical findings of gastric outlet obstruction, confirmed by upper GI-endoscopy and/or upper GI X-ray, had endoscopic placement of expandable metal stents (Microvasive, 6 cm, 22 mm). In two patients , combined stenting of the duodenum and common bile duct was performed as a one step procedure. All patients had primary or metastatic malignancy involving the pylorus or duodenum. The mean age of the patients was 75 years. The first patient (71 years) had a breast carcinoma with metastasis in hilar lymph nodes, invading the common bile duct and subsequently causing gastric-outlet obstruction. The second patient (80 years) had a tumor in the head of the pancreas with liver metastasis, obstructive jaundice and secondary gastric-outlet obstruction. The third patient (74 years) had a cancer of the stomach, obstructing the pyloric region. No surgical procedure was performed because of the high age of the patients and the poor prognosis, suspected by the presence of metastatic disease. Results: Stent placement was successful in all patients. The procedure was followed by immediate clinical improvement, without complications. In case of a double endoscopic stenting procedure, transpyloric dilation was carried out, using a 18 mm balloon, in order to achieve access to the duodenum. After insertion of a biliary Wallstent, a guidewire was introduced in the third part of the duodenum. Subsequently, a Wallstent Enteral was released in the bulboduodenal region. All patients had excellent palliation with normal oral feeding within 24 to 48 hours. Two patients died after a mean of 7 weeks and could tolerate oral feeding well until 2-3 days before they died. The third patient is still alive after 6 weeks, without any complaint, and normal oral feeding so far. Conclusion: An endoscopically placed Wallstent provides effective palliation for malignant gastric-outlet obstruction. The procedure is easy to perform, non-invasive and well tolerated, with significant improvement in quality of live.