Treatment of malignant gastric outlet obstruction with metallic stents: assessment of whether gastrointestinal position alters efficacy.

OBJECTIVES

Gastric outlet obstruction (GOO) is a late complication of advanced gastric, pancreatic, and duodenal cancer. Palliative treatment of the obstruction is the main aim of therapy for these patients. Self-expandable metal stents are used for treating GOO. From our experience, the placement of the stent across the pylorus is easier and makes the curve of stent better than when the stent is placed within the duodenal area. The purposes of this study were to assess the efficacy of stents placed in either the duodenal area or across the pyloric valve in relieving GOO symptoms and to evaluate whether the location of the stent affects treatment outcomes.

MATERIALS AND

METHODS

This was a retrospective single-site study of 44 patients with malignant GOO. Expanding metal stents were placed either across the pyloric valve (n = 22; group A) or in the duodenum area (n = 22; group B). Improvement in oral intake was monitored using the Gastric Outlet Obstruction Scoring System (GOOSS). The end of the study was death of the last enrolled patient or 6 months after enrollment of the last patient, or whatever came first.

RESULTS

Stent implantation similarly improved the patients' tolerance for food intake from baseline for both groups A and B (median [interquartile range]; 2 [2-3] and 2 [2-3], respectively). Patients in group B who received adjunctive chemotherapy had greater improvement in GOOSS and survival than patients in group B who did not have chemotherapy or any group A patients (P < 0.05). Stent patency was not affected by stent position or chemotherapy.

CONCLUSION

Palliative treatment of GOO with placement of an expandable metal stent improved the tolerability of food intake. The location of stent across the pyloric valve or within the duodenum did not affect the efficacy of the procedure or stent patency.