TITLE

ENDOSCOPICALLY PLACED METAL STENTS FOR THE PALLIATION OF MALIGNANT GASTRODUODENAL OBSTRUCTION: THE TREATMENT OF CHOICE

AUTHOR(S)
Holt, A.; Hulley, C.; Ahmed, M.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA73
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: Self-expanding metal stents (SEMS) have been used to re-canalise a variety of obstructed tubular organs. Their use in the stomach and duodenum has recently been described. We report our sing]e-centre experience with the technique in palliating malignant gastroduodenal obstruction. Patients and Methods: Stenting was attempted in 16 patients (11 male, 5 female; mean age 79 years, range 64-91 years). Eleven patients had inoperable gastric cancer, four patients presented with duodenal obstruction due to pancreatic cancer and one patient had tumour overgrowth of a gastro-jejunostomy. We employed SEMS (Schneider Enteral Wallstentâ„¢ in 15 cases and a Flamingo stent in one case, Boston Scientific) over a 0.035" Amplatz wire through a large channel gastroscope or therapeutic duodenoscope. The uncovered Enteral Wallstents were 6 or 9 cm in length and 20 or 22 mm in diameter (after deployment). Positioning of the stent was monitored by fluoroscopy. Results: Gastroduodenal stenting was technically successful in 14/16 patients and 3/16 patients also had metal biliary stenting. The two failures were due to kinking of the stent assembly in one case and complete duodenal obstruction preventing passage of the guide wire in the other. There were no immediate or late stent related complications. The 14 successfully stented patients all experienced relief from vomiting. 11 patients tolerated semi-solid diet, 1 tolerated liquid diet only and the remaining 2 patients were too unwell to eat. After stenting, 10 patients were successfully discharged to home (8) or hospice (2). The median time to discharge was 7 days (range 4-26 days). The mean survival post-procedure was 49 days (median 34 days, range 6-210 days). Conclusion: Gastroduodenal stenting allows effective, minimally invasive palliation of malignant gastroduodenal obstruction. With careful patient selection and appropriate timing, stents relieve the distressing symptom of vomiting and allow safe discharge....
ACCESSION #
9747774

 

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