%0 Journal Article
%T Gastroduodenal Outlet Obstruction and Palliative Self-Expandable Metal Stenting: A Dual-Centre Experience
%A Nik S. Ding
%A Sina Alexander
%A Michael P. Swan
%A Christopher Hair
%A Patrick Wilson
%A Emma Clarebrough
%A David Devonshire
%J Journal of Oncology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/167851
%X Background. Self-expandable metal stents (SEMs) are increasingly being utilised instead of invasive surgery for the palliation of patients with malignant gastroduodenal outlet obstruction. Aim. To review two tertiary centres＊ experience with placement of SEMs and clinical outcomes. Methods. Retrospective analysis of prospectively collected data over 12 years. Results. Ninety-four patients (mean age, 68; range 28每93 years) underwent enteral stenting during this period. The primary tumour was gastric adenocarcinoma in 27 (29%) patients, pancreatic adenocarcinoma in 45 (48%), primary duodenal adenocarcinoma in 8 (9%), and cholangiocarcinoma and other metastatic cancers in 14 (16%). A stent was successfully deployed in 95% of cases. There was an improvement in gastric outlet obstruction score (GOOS) in 84 (90%) of patients with the ability to tolerate an enteral diet. Median survival was 4.25 months (range 0每49) without any significant differences between types of primary malignancy. Mean hospital stay was 3 days (range 1每20). Reintervention rate for stent related complications was 5%. Conclusion. The successful deployment of enteral stents achieves excellent palliation often resulting in the prompt reintroduction of enteral diet and early hospital discharge with minimal complications and reintervention. 1. Introduction Malignant gastroduodenal obstruction is a late and severe complication that develops in up to 20% of patients with advanced carcinoma of the pancreas, stomach, or the duodenum [1每3]. Patients may present with nausea, vomiting, and weight loss with resultant impairment in quality of life [4]. Palliative interventional procedures, either surgical or endoscopic, offer a rapid nonpharmacological modality to improve symptoms as measured by the gastric outlet obstruction score (GOOS) [5]. Although surgery for established gastric outlet obstruction is technically successful in up to 90% of patients [6], it is often associated with a prolonged hospital stay and sometimes with poor function of gastroenterostomy [7]. Curative surgical resection is often not possible and palliative surgical bypass operations have been associated with high mortality and morbidity rates of up to 30% and 50%, respectively [8每10]. Even with the improvements in surgical care and laparoscopic techniques, the more recent reported rates of mortality and morbidity are 10% and 30%, respectively [11每13]. Self-expandable metal stents (SEMs) are devices that are used in the alimentary tract to help alleviate symptoms caused by oesophageal, gastroduodenal, biliary, and colonic
%U http://www.hindawi.com/journals/jo/2013/167851/