OGC P36 The role of self-expanding metallic stents and surgical gastric bypass for palliation of gastric outlet obstruction caused by gastric cancer

Abstract

Abstract Background The treatment of inoperable gastric cancer, causing gastric outlet obstruction (GOO) is focused on palliation of symptoms. Self-expanding metallic stent (SEMS) or surgical gastric bypass (SGB) are used to relieve GOO. Available data on SEMS and SGB are often unreliable as studies usually include patients with different causes of GOO including pancreatic or duodenal cancers or extrinsic disease. Their utility for GOO due to gastric cancer remains uncertain as gastric motility and function could be affected by the pathology. We aim to review outcomes of SEMS and SGB for GOO from gastric cancer in our unit over a 5-year period. Methods Retrospective review of all patients who have had SEMS or SGB for palliation of GOO from gastric cancer between 01/01/2018 and 31/12/2022. Data was collected on the pathology of the tumour, pre-intervention symptoms scoring, post-intervention symptoms scoring, length of stay, complications and survival. Thirty-five patients were identified and included in the study. Results Thirty patients with SEMS and five patients with SGB were analysed. Median survival was 16 weeks. Median length of stay after SEMS was 5.5 days (IQR: 1.2-12.7, range 1-83) and after SGB was 10 days (IQR: 9-11, range 8-32). 2/30 in the SEMS group had early complication requiring re-stenting and 1/5 in SGB group had early complication requiring further surgery and subsequent SEMS. Complete palliation of obstruction was achieved in 17/21 (70%) of SEMS and 4/9 (40%) of SGB patients. Complete palliation with SEMS was more likely when stomach cancer was localised (81%) rather than widespread (44%). Conclusions Self-expanding metallic stents are safe and effective in the palliation of symptoms in patients with gastric outlet obstruction due to gastric cancer and perhaps function better than surgical bypass. They are more effective when the obstructing gastric cancer is localised disease. Longer hospital stay associated with surgical bypass may compromise the palliative process when the survival is often limited.