TITLE

ENTERAL STENTS FOR THE PALLIATION OF MALIGNANT GASTRIC AND DUODENAL OBSTRUCTION

AUTHOR(S)
Lindsay, J.O.; Vlavianos, P.; Andreyev, H.J.N.; Westaby, D.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA72
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: Gastric outlet and duodenal obstruction are common complications of advanced upper gastrointestinal malignancy. Relief of obstruction to allow continued enteral feeding and early discharge is the primary therapeutic goal. Surgical bypass has a high success rate, but is not appropriate or feasible in all patients. The endoscopic placement of expandable metal stents has been proposed as an alternative technique to achieve palliation in patients not suitable for surgery. Aim: To review our experience with gastroduodenal metal stent insertion for the palliation of malignant gastric and duodenal obstruction in patients unsuitable for surgical bypass. Methods: A retrospective review of the notes of all patients who had a gastroduodenal stent inserted in our unit between March 1999 and October 2002 was performed. In addition, the referring consultant and GP were contacted to obtain follow up information. Results: 29 patients (17 male, 12 female) with a mean (range) age of 66 (43-93) underwent insertion of an enteral stent for malignant gastric or duodenal obstruction. The primary tumour was in the stomach in 14 (48%), the pancreas in 10 (34%) patients, and metastatic in 5 (17%) patients. A stent was successfully placed in all patients; the sites of placement included the stomach (n=5), across the pylorus (n = 6), through a previous surgical anastomosis (n = 3), or the duodenum (n = 15). Two stents blocked after insertion, one required dilatation, and the other patient had a second stent inserted. No patients required surgery. 26 patients have subsequently died, the median (range) survival being 2.8 months (2 weeks to 10 months), 22 patients survived at least one month. 25 (86%) patients were discharged from hospital: 19 home, 6 to a hospice. During follow up 8 (27%) patients returned to a solid diet, 17 (59%) required a soft diet, and 3 (10%) patients tolerated liquids only. Conclusion: The use of enteral stents achieves good palliation in the majority...
ACCESSION #
9747771

 

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