Endoscopy 2003; 35(6): 483-489
DOI: 10.1055/s-2003-39661
Original Article

© Georg Thieme Verlag Stuttgart · New York

Endoscopic Palliation of Malignant Gastric Outlet Obstruction Using Self-Expandable Metallic Stents: Results of a Multicenter Study

T.  Nassif 1 , F.  Prat 1, 2 , B.  Meduri 2 , J.  Fritsch 1 , A.  D.  Choury 1 , J.  L.  Dumont 2 , J.  Auroux 3 , B.  Desaint 4 , B.  Boboc 5 , P.  Ponsot 6 , J.  P.  Cervoni 7
  • 1 Department of Gastroenterology, CHU Bicêtre, Le Kremlin-Bicêtre, France
  • 2 Bachaumont Endoscopy Center, Paris, France
  • 3 Department of Gastroenterology, CHU Henri Mondor, Créteil, France
  • 4 Department of Gastroenterology, CHU St. Antoine, Paris, France
  • 5 Department of Gastroenterology, CHU Georges Pompidou, Paris, France
  • 6 Department of Gastroenterology, CHU Beaujon, Clichy, France
  • 7 Department of Gastroenterology, Chartres Hospital, Chartres, France
Further Information

Publication History

Submitted 6 June 2002

Accepted after Revision 7 November 2002

Publication Date:
03 June 2003 (online)

Background and Study Aims: Gastric outlet obstruction is a late event in the natural history of biliopancreatic tumours. Metallic self-expanding stents inserted under endoscopic and fluoroscopic guidance can be used for palliation. The aim of this study was to evaluate the feasibility, efficacy, and complications of endoscopic duodenal stenting in patients with malignant gastric outlet obstruction.
Patients and Methods: Between August 1998 and November 2001, 63 patients (31 women, 32 men; mean age 73 ± 12) presenting with clinical symptoms of duodenal obstruction underwent endoscopic stenting with large metallic prostheses. Complications and clinical outcome were assessed both retrospectively and prospectively.
Results: Of the patients, 58 needed one duodenal stent and two overlapping stents were required in five patients. Stenting was immediately successful in 60/63 patients (95 %). At the time of the duodenal procedure, 25 previously inserted biliary stents were still patent; biliary stenting was attempted during the same procedure in 18 patients; and 20 patients had no biliary stricture. There was no procedure-related mortality. There were complications in 30 % of patients: 13 stent obstructions, 4 stent migrations and 2 duodenal perforations (treated surgically). For 44 patients (70 %) there were no minor or major digestive problem during their remaining lifetime. An exclusively peroral diet was possible in 58 patients (92 %), but was considered satisfactory (solid or soft) in 46/63 patients (73 %). Of the patients, 53 (84 %) died between 1 and 64 weeks after the duodenal stenting (median survival 7 weeks).
Conclusions: Endoscopic stenting for the palliation of malignant gastric outlet obstruction is feasible and well-tolerated in most patients. Most dysfunctions can be managed endoscopically.

References

F. Prat, M.D.

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