Primary palliative treatment of malignant gastric outlet obstruction with a self-expanding metal stent

Abstract

A high operative mortality, diffuse local tumor growth and abnormal wound healing are significant risk factors in the palliative surgical treatment of gastric outlet obstruction caused by a malignant tumor. This study was undertaken to evaluate the use of self-expanding metal stents as an alternative. Over a period of 33 months, nine previously unoperated patients (three women, six men; mean age 71.4 [66-76] years) with gastric outlet obstruction by a malignant tumor underwent endoscopic implantation of an uncoated self-expanding nitinol Ultraflex stent. The stent's length was 7 and 10 cm, respectively, the length of the carrier catheter was 92 cm. The stent was implanted after balloon dilatation of the stenosis and marking the distal tumor margin with lipiodol injected over a guide-wire under fluoroscopic control. The implantation was successful in only two of the first five patients, but after modifying the method of stent release in three of the four subsequent patients. All patients reported an improved quality of life. One patient died after 10 days of the underlying malignancy. There were no complications associated with the implantation. Insertion of a self-expanding metal stent can provide palliation in patients with inoperable gastric outlet stenosis due to malignant tumour. The number of successful implantations can probably be increased by optimizing some of the devices used, for example by lengthening the carrier catheter.