Stenting For Gastric Outlet Obstruction Research Articles

Clinical outcome of a highly flexible duodenal stent for gastric outlet obstruction: A multicenter prospective study.

Background and AimEndoscopic duodenal stenting for patients with malignant gastric outlet obstruction (GOO) has been widespread; however, clinical trials evaluating the structures of duodenal stents are lacking. Thus, we aimed to investigate the clinical outcomes of a highly flexible duodenal stent for GOO patients.MethodsA prospective study of duodenal stenting for GOO patients from five hospitals between August 2017 and August 2018 was performed. WallFlex Duodenal Soft were used in all procedures. The primary endpoint was clinical success, defined as an improvement in the GOO scoring system.ResultsThe study enrolled 31 patients (12 women, 19 men) with GOO, with a median age of 70 (range 52–90) years. Primary diseases were pancreatic cancer, gastric cancer, biliary tract cancer, and others in 14, 10, 3, and 4 patients, respectively. The technical success rate was 97%, and the clinical success rate was 87%. Simultaneous biliary drainage was performed in 19% of patients. Adverse events occurred in three patients. Chemotherapy was given in 41% of clinically successful cases, and the median overall survival time after stent placement was 82 days (range, 30–341 days), and. Stent dysfunction occurred in 30% of clinically successful cases (stent ingrowth in seven and stent overgrowth in one patient). The median time to stent dysfunction was 157 days (range, 11–183 days). Six patients were treated with additional stent placement after dysfunction.ConclusionPlacement of a highly flexible duodenal stent is an effective and safe treatment for patients with GOO (UMIN‐CTR 000028783).

Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction.

Background and study aims EUS-guided gastroenterostomy (GE) is a novel, minimally invasive endoscopic procedure for the treatment of gastric outlet obstruction (GOO). The direct-EUS-GE (D-GE) approach has recently gained traction. We aimed to report on a large cohort of patients who underwent DGE with focus on long-term outcomes. Patients and methods This two-center, retrospective study involved consecutive patients who underwent D-GE between October 2014 and May 2018. The primary outcomes were technical and clinical success. Secondary outcomes were adverse events (AEs), rate of reintervention, procedure time, time to resume oral diet, and post-procedure length of stay (LOS). Results A total of 57 patients (50.9 % female; median age 65 years) underwent D-GE for GOO. The etiology was malignant in 84.2 % and benign in 15.8 %. Technical success and clinical success were achieved in 93 % and 89.5 % of patients, respectively, with a median follow-up of 196 days in malignant GOO and 319.5 days in benign GOO. There were 2 (3.5 %) AEs, one severe and one moderate. Median procedure time was 39 minutes (IQR, 26 – 51.5 minutes). Median time to resume oral diet after D-GE was 1 day (IQR 1 – 2 days). Median post D-GE LOS was 3 days (IQR 2 – 7 days). Rate of reintervention was 15.1 %. Conclusions D-GE is safe and effective in management of both malignant and benign causes of GOO. Clinical success with D-GE is durable with a low rate of reintervention based on a long-term cohort.

A case of enteral stent for gastric outlet obstruction following pancreaticoduodenectomy

A case of enteral stent for gastric outlet obstruction following pancreaticoduodenectomy

Endoscopic duodenal stenting for gastric outlet obstruction in patients with advanced pancreatic cancer

Endoscopic duodenal stenting for gastric outlet obstruction in patients with advanced pancreatic cancer

Mo2013 The Efficacy of an Endoscopic Self-Expandable Metal Stent for Gastric Outlet Obstruction (GOO) By Malignancies

Gastric Outlet Obstruction (GOO) may be caused by malignant diseases of the stomach, pancreas and duodenum or by lymphonodal metastasis. GOO causes intractable nausea and vomiting, abdominal distention and deficient oral intake, resulting in progressive deterioration of the patient’s quality of life (QOL). Advances in chemotherapeutic treatment have improved the prognoses of these types of cancer and the incidence of malignant GOO has increased both at the time of diagnosis and during the course of anticancer treatment. Self-expandable metal stent (SEMS) placement has widely been evaluated as a therapeutic alternative to surgical bypass for managing GOO with minimal invasion.

Stent under-expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction.

Self-expandable metallic stents (SEMS) have been widely accepted as palliation therapy for malignant gastric outlet obstruction (GOO). However, the factors predictive of poor oral intake after SEMS placement have not been elucidated sufficiently. We aimed to clarify both the patient and stent-related predictive factors. We retrospectively reviewed 126 consecutive patients who underwent uncovered SEMS placement for malignant GOO between April 2010 and March 2013 at a university hospital and two tertiary care referral centers. Technical success of SEMS placement was achieved in all 126 (100%) patients. Improved oral intake was observed in 111 (88.1%) patients. A Karnofsky performance status ≤ 40 (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.02-1.28; P = 0.041), peritoneal dissemination (OR, 1.20; 95% CI, 1.01-1.26; P = 0.038), and under-expansion of the SEMS on the procedure day (OR, 1.55; 95% CI, 1.26-1.62; P < 0.001) were independent predictive factors for poor improvement on the GOO scoring system, according to multivariate analysis. SEMS under-expansion was a stent related, while poor performance status and peritoneal dissemination were patient related, predictive factors for poor oral intake after SEMS placement for malignant GOO.

Efficacy of endoscopic gastroduodenal stenting for gastric outlet obstruction due to unresectable advanced gastric cancer: A prospective multicenter study

Gastroduodenal stents for gastric outlet obstruction due to unresectable advanced gastric cancer are increasingly used; however, their effects have not been fully evaluated. A multicenter prospective observational study was performed. Patients were eligible if they had stage IV gastric cancer with a gastric outlet obstruction scoring system (GOOSS) score of 0 (no oral intake) or 1 (liquids only). Self-expandable metallic stents were delivered endoscopically. The effects of stents were evaluated. Twenty patients were enrolled and 18 were eligible (15 men, three women; median age, 70 years). Stent placement was successfully performed in all patients, with no complications. After stenting, a GOOSS score of 2 (soft solids only) or 3 (low-residue or full diet) was achieved in 13 (72%) patients. An improvement in the GOOSS score by one or more points was obtained in 16 (94%) patients. The median duration of fasting and hospital stay was 3 (range, 0-9) days and 18 (6-168) days, respectively. Chemotherapy was performed after stenting in 13 (72%) patients. Gastroduodenal stents are thought to be feasible, safe, and effective for gastric outlet obstruction due to unresectable advanced gastric cancer, with rapid clinical relief and a short hospital stay.

Endoscopic stenting for gastric outlet obstruction in patients with unresectable antro pyloric cancer. Systematic review of the literature and final results of a prospective study. The point of view of a surgical group

BackgroundThe authors report the final results of a prospective single-center randomized study whose aim was to compare the endoscopic placement of self-expandable stents with open surgical gastroenterostomy to relieve gastric outlet obstruction (GOO) in patients with advanced antropyloric adenocarcinoma. A systematic review of the medical literature from December 1999 to December 2011 was carried out to determine the results of endoscopic stenting in patients with GOO from unresectable primary cancer of the antropyloric region. MethodsIn the prospective study, 18 patients with advanced adenocarcinoma of the antropyloric region and symptoms of GOO were enrolled. In 9 patients, self-expandable stents were placed, and in 9 patients, open surgical gastroenterostomy was performed. Patients were followed until death. Six hundred seventy-two patients with primary unresectable cancer of the antropyloric region and GOO syndrome who underwent endoscopic stenting were identified from the literature. ResultsIn the prospective study of 18 patients, there was no case of postprocedural mortality. Efficient gastric emptying resumed more quickly in patients who received stents, although 3 months after the procedures, there was no difference between the 2 groups. Mean crude survival was 258 days in patients who received stents and 283 days in those who underwent surgical gastroenterostomy (P = NS). In patients who underwent stent placement, there were 2 cases of stent migration and 2 cases of food impaction, which were resolved with endoscopy at a mean follow-up of 70 days. In the 672 patients from the literature, operative mortality and morbidity were very low. In prospective studies, complications related to stents were more common than previously thought. ConclusionsEndoscopic placement of metallic stents offers an effective therapy in patients with advanced primary adenocarcinoma of the antropyloric region and poor general condition. In patients with longer life expectancies, the form of therapy should be chosen individually, considering that surgical gastroenterostomy has fewer complications in the medium term and that in patients with endoscopic stenting, very careful follow-up is required, with the possibility of new operative endoscopy in half of the patients.

Placement of Self-Expandable Metal Stents for Gastric Outlet Obstruction

Malignant gastric outlet obstruction (GOO) may occur as a preterminal event in patients with a variety of unresectable cancers. Given that they provide significantly lower morbidity and mortality rates than surgical alternatives, self-expandable metallic stents (SEMS) are now widely used in the palliation of malignant GOOs. Although recently developed dedicated through-the-scope stents may facilitate the placement procedure, a full understanding of the specs and physical properties of SEMS are still essential. In addition, an understanding of optimal placement is also critical, and will aid in improving clinical efficacy and preventing potential adverse events. Here, a collection of ideas and insights into stent placement for malignant GOO is presented. This article is part of an expert video encyclopedia.

A newly designed big cup nitinol stent for gastric outlet obstruction

To find out whether a newly designed big cup nitinol stent is suitable for treatment of patients with gastric outlet obstruction resulting from gastric cancer. The new stent is composed of a proximal big cup segment (20 mm in length and 48-55 mm in diameter), a middle part (60 mm in length and 20 mm in diameter) covered by a polyethylene membrane and a distal sphericity (20 mm in length and 28 mm in diameter). Half of the proximal big cup segment is also covered by a polyethylene membrane, which is adjacent to the middle part of the stent. The stent is preloaded in a 6.0-mm-diameter introducer system. Thirteen patients with gastric outlet obstruction resulting from gastric cancer received the new stents under endoscopic and fluoroscopic guidance. Technical success was achieved in 12 of 13 (92.3%) patients. Among the 12 patients in whom endoscopic stent was placed successfully, the clinical success rate was 91.7% during a follow-up of average 6.5 mo. During the first month follow-up, the migration rate was 0%, recurrent obstruction 0% and gastric bleeding 8.3%. During the follow-up between 2-12 mo, no migration, recurrent obstruction and gastric bleeding occurred. The proximal big cup segment seems to be effective and promising for technical efficacy, clinical outcome, and preventing migration and tumor ingrowth and increasing the emptying rate of sinus ventriculi.

Metallic stents for gastric outlet obstruction: reintervention rate is lower with uncovered versus covered stents, despite similar outcomes

Self-expandable metallic stents (SEMSs) are widely used for palliation of malignant gastric outlet obstruction (GOO). A common complication of their use, however, is stent obstruction caused by tumor ingrowth or hyperplasia. The covered SEMS was designed to prevent these problems. We compared the performance of uncovered and covered SEMSs in patients with GOO. A retrospective study, single center. A tertiary-referral center. Sixty patients with symptomatic malignant GOO. All patients received an uncovered or covered knitted nitinol stent by using the over-the-wire placement procedure. Comparison of the clinical outcome, complications, and the reintervention rate between uncovered and covered stents. Thirty-one patients (mean [+/-SEM] age 72.2 +/- 2.1 years; 16 men) received uncovered SEMSs, and 29 (mean [+/-SEM] age 70.6 +/- 1.7 years; 17 men) received covered SEMSs. The technical success rate was 100% in both groups. No difference in clinical success was seen (90.3% uncovered group vs 86.2% covered group). Regarding early complications (<1 week), one mild case of pancreatitis from the stent covering the papilla occurred in each group. Late complications included reobstruction, migration, bleeding, stent fracture, and perforation. The occurrence of reobstruction did not differ between the 2 groups (3.2% uncovered group vs 10.3% covered group). No difference in migration (0% uncovered group vs 6.9% covered group) was seen. The uncovered group required less frequent reinterventions for stent reobstruction, migration, or stent fracture (3.2% uncovered group vs 20.7% covered group, P = .0490). The uncovered group had 2 major late complications: bleeding and perforation. All 60 patients died, with a median survival time of 51 days and 62 days, respectively. Small-sized, single-center, retrospective study. In palliation for malignant GOO, covered stents were associated with a more frequent need for reintervention than uncovered stents, despite similar outcomes and complications. These results require confirmation in a larger randomized comparison.

Self-expanding metallic stents for gastric outlet obstruction resulting from stomach cancer: a preliminary study with a newly designed double-layered pyloric stent

Although endoscopic stent placement is now generally accepted as a palliative treatment for gastric outlet obstruction resulting from gastric cancer, it carries potential limitations such as tumor ingrowth or migration. Our purpose was to evaluate the technical and clinical efficacy of endoscopic placement of a newly designed double-layered combination pyloric stent. Prospective, uncontrolled, single-center. Tertiary referral university hospital. Eleven patients with gastric outlet obstruction by unresectable stomach cancer. Eleven patients received a double-layered combination pyloric stent (an outer uncovered stent to reduce migration and an inner polytetrafluoroethylene-covered stent to prevent tumor ingrowth). To evaluate technical success, clinical success, and complications, especially tumor ingrowth and migration. Technical success was achieved in 11 of 11 (100%) patients. Among 11 patients in whom endoscopic stenting was placed successfully, clinical success was 90.9%, tumor ingrowth 0%, migration 9.1%, and tumor overgrowth 9.1%. Median stent patency period was 121 days. Small number of patients, uncontrolled study, short-term follow-up period. We have described a technique for endoscopic metal stent placement by using the newly designed double-layered combination stent for gastric outlet obstruction by stomach cancer. This stent seems to be effective and looks promising for technical efficacy, clinical outcome, and preventing tumor ingrowth and migration.