Digestive Disease Interventions 2018; 02(01): 025-032
DOI: 10.1055/s-0038-1639335
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Minimally Invasive Interventional Management of Gastric Outlet Obstructions

Wei-Zhong Zhou
1   Department of Interventional Radiology, First Affiliate Hospital of Nanjing Medical University, Nanjing, China
,
Zheng-Qiang Yang
1   Department of Interventional Radiology, First Affiliate Hospital of Nanjing Medical University, Nanjing, China
› Author Affiliations
Further Information

Publication History

31 October 2017

05 February 2018

Publication Date:
20 April 2018 (online)

Abstract

Gastric outlet obstruction (GOO) is a clinical consequence of any disease that produces intrinsic or extrinsic obstruction of the pyloric channel or duodenum. The most common symptoms of GOO include nausea, vomiting, abdominal pain, and weight loss. Traditionally, surgery is regarded as the standard treatment modality. However, with the development of mini-invasive technologies, fluoroscopic or endoscopic stenting and balloon dilatation have become the mainstream of the therapies. The initial recommended treatment for malignant GOO is self-expanding metal stent placement. The stent can be classified into covered and uncovered stent according to whether it is coated with a membrane. Covered stent seems to have longer stent patency, while uncovered stent has the advantage of a lower migration rate. Regarding the etiology of benign GOO, peptic ulcer disease and corrosive injury are the two main reasons. Balloon dilatation is a simple and convenient way to treat the benign GOO. Stent placement has recently been reported for the treatment of benign GOO; however, it needs further more studies to verify its effect. This article presents a concise review of current fluoroscopic or endoscopic stenting practice for malignant GOO and balloon dilatation or stenting for benign GOO.

 
  • References

  • 1 Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002; 97 (01) 72-78
  • 2 Lopera JE, Brazzini A, Gonzales A, Castaneda-Zuniga WR. Gastroduodenal stent placement: current status. Radiographics 2004; 24 (06) 1561-1573
  • 3 Rana SS, Bhasin DK, Chandail VS. , et al. Endoscopic balloon dilatation without fluoroscopy for treating gastric outlet obstruction because of benign etiologies. Surg Endosc 2011; 25 (05) 1579-1584
  • 4 Lillemoe KD, Cameron JL, Hardacre JM. , et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 1999; 230 (03) 322-328 , discussion 328–330
  • 5 Isla AM, Worthington T, Kakkar AK, Williamson RC. A continuing role for surgical bypass in the palliative treatment of pancreatic carcinoma. Dig Surg 2000; 17 (02) 143-146
  • 6 Johnsson E, Thune A, Liedman B. Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World J Surg 2004; 28 (08) 812-817
  • 7 Mittal A, Windsor J, Woodfield J, Casey P, Lane M. Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 2004; 91 (02) 205-209
  • 8 Maetani I, Akatsuka S, Ikeda M. , et al. Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy. J Gastroenterol 2005; 40 (10) 932-937
  • 9 Kochhar R, Sethy PK, Nagi B, Wig JD. Endoscopic balloon dilatation of benign gastric outlet obstruction. J Gastroenterol Hepatol 2004; 19 (04) 418-422
  • 10 Fiori E, Lamazza A, Volpino P. , et al. Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res 2004; 24 (01) 269-271
  • 11 Pinto IT. Malignant gastric and duodenal stenosis: palliation by peroral implantation of a self-expanding metallic stent. Cardiovasc Intervent Radiol 1997; 20 (06) 431-434
  • 12 Gutzeit A, Binkert CA, Schoch E, Sautter T, Jost R, Zollikofer CL. Malignant gastroduodenal obstruction: treatment with self-expanding uncovered wallstent. Cardiovasc Intervent Radiol 2009; 32 (01) 97-105
  • 13 Kim JH, Song HY, Shin JH. , et al. Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 2007; 66 (02) 256-264
  • 14 Brimhall B, Adler DG. Enteral stents for malignant gastric outlet obstruction. Gastrointest Endosc Clin N Am 2011; 21 (03) 389-403 , vii–viii vii–viii
  • 15 Woo SM, Kim DH, Lee WJ. , et al. Comparison of uncovered and covered stents for the treatment of malignant duodenal obstruction caused by pancreaticobiliary cancer. Surg Endosc 2013; 27 (06) 2031-2039
  • 16 Katsanos K, Sabharwal T, Adam A. Stenting of the upper gastrointestinal tract: current status. Cardiovasc Intervent Radiol 2010; 33 (04) 690-705
  • 17 Boškoski I, Tringali A, Familiari P, Mutignani M, Costamagna G. Self-expandable metallic stents for malignant gastric outlet obstruction. Adv Ther 2010; 27 (10) 691-703
  • 18 Jung GS, Song HY, Seo TS. , et al. Malignant gastric outlet obstructions: treatment by means of coaxial placement of uncovered and covered expandable nitinol stents. J Vasc Interv Radiol 2002; 13 (03) 275-283
  • 19 Kim DH, Kang SG, Choi JR, Byun JN, Kim YC, Ahn YM. Evaluation of the biodurability of polyurethane-covered stent using a flow phantom. Korean J Radiol 2001; 2 (02) 75-79
  • 20 Kim JH, Song HY, Shin JH. , et al. Membrane degradation of covered stents in the upper gastrointestinal tract: frequency and clinical significance. J Vasc Interv Radiol 2008; 19 (2 Pt 1): 220-224
  • 21 Minata MK, Bernardo WM, Rocha RS. , et al. Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review. Endosc Int Open 2016; 4 (11) E1158-E1170
  • 22 Kato H, Tsutsumi K, Okada H. Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction. Ann Transl Med 2017; 5 (08) 186
  • 23 Sabharwal T, Irani FG, Adam A. ; Cardiovascular and Interventional Radiological Society of Europe. Quality assurance guidelines for placement of gastroduodenal stents. Cardiovasc Intervent Radiol 2007; 30 (01) 1-5
  • 24 Zollikofer CL, Jost R, Schoch E, Decurtins M. Gastrointestinal stenting. Eur Radiol 2000; 10 (02) 329-341
  • 25 Morgan R, Adam A. Use of metallic stents and balloons in the esophagus and gastrointestinal tract. J Vasc Interv Radiol 2001; 12 (03) 283-297
  • 26 Jung GS, Song HY, Kang SG. , et al. Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology 2000; 216 (03) 758-763
  • 27 Song HY, Shin JH, Yoon CJ. , et al. A dual expandable nitinol stent: experience in 102 patients with malignant gastroduodenal strictures. J Vasc Interv Radiol 2004; 15 (12) 1443-1449
  • 28 Jeurnink SM, Repici A, Luigiano C, Pagano N, Kuipers EJ, Siersema PD. Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction. Surg Endosc 2009; 23 (03) 562-567
  • 29 Zhou WZ, Yang ZQ, Liu S. , et al. A newly designed stent for management of malignant distal duodenal stenosis. Cardiovasc Intervent Radiol 2015; 38 (01) 177-181
  • 30 Baerlocher MO, Asch MR, Dixon P, Kortan P, Myers A, Law C. ; Canadian Interventional Radiology Association. Interdisciplinary Canadian guidelines on the use of metal stents in the gastrointestinal tract for oncological indications. Can Assoc Radiol J 2008; 59 (03) 107-122
  • 31 Park JH, Song HY, Kim MS. , et al. Usefulness of a guiding sheath for fluoroscopic stent placement in patients with malignant gastroduodenal obstruction. Acta Radiol 2013; 54 (03) 267-271
  • 32 Miller BHT, Griffiths EA, Pursnani KG, Ward JB, Stockwell RC. An assessment of radiologically inserted transoral and transgastric gastroduodenal stents to treat malignant gastric outlet obstruction. Cardiovasc Intervent Radiol 2013; 36 (06) 1591-1601
  • 33 Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol 2007; 7: 18
  • 34 Park KB, Do YS, Kang WK. , et al. Malignant obstruction of gastric outlet and duodenum: palliation with flexible covered metallic stents. Radiology 2001; 219 (03) 679-683
  • 35 Kaw M, Singh S, Gagneja H, Azad P. Role of self-expandable metal stents in the palliation of malignant duodenal obstruction. Surg Endosc 2003; 17 (04) 646-650
  • 36 Masci E, Viale E, Mangiavillano B. , et al. Enteral self-expandable metal stent for malignant luminal obstruction of the upper and lower gastrointestinal tract: a prospective multicentric study. J Clin Gastroenterol 2008; 42 (04) 389-394
  • 37 Tringali A, Didden P, Repici A. , et al. Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study. Gastrointest Endosc 2014; 79 (01) 66-75
  • 38 Lim SG, Kim JH, Lee KM. , et al. Conformable covered versus uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction: a randomized prospective study. Dig Liver Dis 2014; 46 (07) 603-608
  • 39 Park CI, Kim JH, Lee YC. , et al. What is the ideal stent as initial intervention for malignant gastric outlet obstruction?. Dig Liver Dis 2013; 45 (01) 33-37
  • 40 Maetani I, Mizumoto Y, Shigoka H. , et al. Placement of a triple-layered covered versus uncovered metallic stent for palliation of malignant gastric outlet obstruction: a multicenter randomized trial. Dig Endosc 2014; 26 (02) 192-199
  • 41 Shi D, Ji F, Bao YS, Liu YP. A multicenter randomized controlled trial of malignant gastric outlet obstruction: tailored partially covered stents (placed fluoroscopically) versus standard uncovered stents (placed endoscopically). Gastroenterol Res Pract 2014; 2014: 309797
  • 42 Lee H, Min BH, Lee JH. , et al. Covered metallic stents with an anti-migration design vs. uncovered stents for the palliation of malignant gastric outlet obstruction: a multicenter, randomized trial. Am J Gastroenterol 2015; 110 (10) 1440-1449
  • 43 Jung K, Ahn JY, Jung HY. , et al. Outcomes of endoscopically inserted self-expandable metal stents in malignancy according to the type of stent and the site of obstruction. Surg Endosc 2016; 30 (09) 4001-4010
  • 44 Kim JW, Jeong JB, Lee KL. , et al. Comparison between uncovered and covered self-expandable metal stent placement in malignant duodenal obstruction. World J Gastroenterol 2015; 21 (05) 1580-1587
  • 45 Hori Y, Naitoh I, Hayashi K. , et al. Predictors of outcomes in patients undergoing covered and uncovered self-expandable metal stent placement for malignant gastric outlet obstruction: a multicenter study. Gastrointest Endosc 2017; 85 (02) 340-348.e1
  • 46 Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004; 36 (06) 543-550
  • 47 Nagaraja V, Eslick GD, Cox MR. Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction-a systematic review and meta-analysis of randomized and non-randomized trials. J Gastrointest Oncol 2014; 5 (02) 92-98
  • 48 Maetani I, Tada T, Ukita T, Inoue H, Sakai Y, Nagao J. Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 2004; 36 (01) 73-78
  • 49 Mukherjee S, Kocher HM, Hutchins RR, Bhattacharya S, Abraham AT. Palliative surgical bypass for pancreatic and peri-ampullary cancers. J Gastrointest Cancer 2007; 38 (2-4): 102-107
  • 50 Mehta S, Hindmarsh A, Cheong E. , et al. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc 2006; 20 (02) 239-242
  • 51 Jeurnink SM, Steyerberg EW, van Hooft JE. , et al; Dutch SUSTENT Study Group. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71 (03) 490-499
  • 52 No JH, Kim SW, Lim CH. , et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc 2013; 78 (01) 55-62
  • 53 Goldberg EM. Palliative treatment of gastric outlet obstruction in terminal patients: SEMS. Stent every malignant stricture!. Gastrointest Endosc 2014; 79 (01) 76-78
  • 54 Appasani S, Kochhar S, Nagi B, Gupta V, Kochhar R. Benign gastric outlet obstruction--spectrum and management. Trop Gastroenterol 2011; 32 (04) 259-266
  • 55 Peterson WL. Helicobacter pylori and peptic ulcer disease. N Engl J Med 1991; 324 (15) 1043-1048
  • 56 Lau JY, Chung SC, Sung JJ. , et al. Through-the-scope balloon dilation for pyloric stenosis: long-term results. Gastrointest Endosc 1996; 43 (2 Pt 1): 98-101
  • 57 Solt J, Bajor J, Szabó M, Horváth OP. Long-term results of balloon catheter dilation for benign gastric outlet stenosis. Endoscopy 2003; 35 (06) 490-495
  • 58 Kuwada SK, Alexander GL. Long-term outcome of endoscopic dilation of nonmalignant pyloric stenosis. Gastrointest Endosc 1995; 41 (01) 15-17
  • 59 Kim JH, Shin JH, Song HY. Benign strictures of the esophagus and gastric outlet: interventional management. Korean J Radiol 2010; 11 (05) 497-506
  • 60 Vance PL, de Lange EE, Shaffer Jr HA, Schirmer B. Gastric outlet obstruction following surgery for morbid obesity: efficacy of fluoroscopically guided balloon dilation. Radiology 2002; 222 (01) 70-72
  • 61 Sataloff DM, Lieber CP, Seinige UL. Strictures following gastric stapling for morbid obesity. Results of endoscopic dilatation. Am Surg 1990; 56 (03) 167-174
  • 62 Kim JH, Shin JH, Bae JI. , et al. Gastric outlet obstruction caused by benign anastomotic stricture: treatment by fluoroscopically guided balloon dilation. J Vasc Interv Radiol 2005; 16 (05) 699-704
  • 63 Kochhar R, Dutta U, Sethy PK. , et al. Endoscopic balloon dilation in caustic-induced chronic gastric outlet obstruction. Gastrointest Endosc 2009; 69 (04) 800-805
  • 64 DiSario JA, Fennerty MB, Tietze CC, Hutson WR, Burt RW. Endoscopic balloon dilation for ulcer-induced gastric outlet obstruction. Am J Gastroenterol 1994; 89 (06) 868-871
  • 65 Heo J, Jung MK. Safety and efficacy of a partially covered self-expandable metal stent in benign pyloric obstruction. World J Gastroenterol 2014; 20 (44) 16721-16725
  • 66 Dormann AJ, Deppe H, Wigginghaus B. Self-expanding metallic stents for continuous dilatation of benign stenoses in gastrointestinal tract - first results of long-term follow-up in interim stent application in pyloric and colonic obstructions. Z Gastroenterol 2001; 39 (11) 957-960
  • 67 Choi WJ, Park JJ, Park J. , et al. Effects of the temporary placement of a self-expandable metallic stent in benign pyloric stenosis. Gut Liver 2013; 7 (04) 417-422
  • 68 Bae J-I, Shin JH, Song HY, Lee GH. Treatment of a benign anastomotic duodenojejunal stricture with a polytetrafluoroethylene-covered retrievable expandable nitinol stent. J Vasc Interv Radiol 2004; 15 (07) 769-772
  • 69 Kim PH, Song HY, Park JH. , et al. Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures: experience with a non-endoscopic removal system. Eur Radiol 2017; 27 (03) 1257-1266