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Anand U, Anwar S, Parasar K, Singh BN, Kant K. The Outcome and Survival of Locally Advanced Gastric Cancer with Gastric Outlet Obstruction After Upfront Radical Surgery. Indian J Surg Oncol 2024. [DOI: 10.1007/s13193-024-02163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 12/04/2024] [Indexed: 01/04/2025] Open
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de Oliveira VL, dos Santos MEL, Boghossian MB, de Freitas Júnior JR, Lemos Pires Pereira ML, Turiani CV, de Moura EGH. Double EUS-guided bypass for gastric outlet and biliary tract malignant obstruction: A standardized one-step approach (with videos). Endosc Ultrasound 2024; 13:271-272. [PMID: 39318755 PMCID: PMC11419474 DOI: 10.1097/eus.0000000000000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/27/2024] [Indexed: 09/26/2024] Open
Affiliation(s)
- Victor Lira de Oliveira
- Gastrointestinal Endoscopy Unit—Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Marcos Eduardo Lera dos Santos
- Gastrointestinal Endoscopy Unit—Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Mateus Bond Boghossian
- Gastrointestinal Endoscopy Unit—Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - João Remí de Freitas Júnior
- Gastrointestinal Endoscopy Unit—Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | | | - Carolina Vaz Turiani
- Gastrointestinal Surgery Unit—Associação Beneficência Portuguesa de São Paulo, SP, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit—Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
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Harb M, Kamath A, Marx G, Gupta S. Outcomes of endoscopic ultrasound-guided gastro-enterostomy for gastric outlet obstruction in a two-centre Australian Cohort (with video). Asia Pac J Clin Oncol 2023. [PMID: 37771144 DOI: 10.1111/ajco.14013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 08/02/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Endoscopic ultrasound-guided gastro-enterostomy (EUS-GE) is a relatively novel technique that has been shown to require less re-intervention than standard endoscopic enteral stenting for gastric outlet obstruction and is less invasive, quicker, and more cost-effective than surgery. This study evaluated the outcomes and safety of EUS-GE in patients treated for gastric outlet obstruction across two Australian centers. METHODS Retrospective data on demographics, presenting symptoms, disease, endoscopic and clinical outcomes, and safety were collected on all patients who underwent EUS-GE from 2021 to 2022. Descriptive statistics were used to evaluate outcomes and safety and survival were calculated using Kaplan-Meier analysis. RESULTS Eleven patients underwent EUS-GE during the defined period, 10 of whom had a malignant etiology (median age 73 years, interquartile range [IQR] 13; 63.6% male). Technical success was 90.9%. Of those patients, clinical success (the ability to tolerate at least a full liquid diet during follow-up) was 100%. The median length of hospital stay post-procedure was 6 days (IQR 14 days). No severe adverse events occurred, and one patient (10%) required a repeat endoscopy. Median survival post-EUS-GE was 298 days (95% confidence interval 0-730.1 days) CONCLUSION: EUS-GE is an effective, safe, and durable therapy for patients with gastric outlet obstruction. This study presents Australian data on outcomes and safety that is comparable to international literature. EUS-GE should be considered for patients where local expertise allows.
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Affiliation(s)
- Martin Harb
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
- The University of New South Wales, Sydney, Australia
| | - Arvind Kamath
- The Australian National University, Canberra, Australia
- Department of Gastroenterology and Hepatology, The Sydney Adventist Hospital, Sydney, Australia
| | - Gavin Marx
- The Australian National University, Canberra, Australia
- Medical Oncology, The Sydney Adventist Hospital, Sydney, Australia
| | - Saurabh Gupta
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
- The Australian National University, Canberra, Australia
- Department of Gastroenterology and Hepatology, The Sydney Adventist Hospital, Sydney, Australia
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Cheema HI, Tharian B, Inamdar S, Garcia-Saenz-de-Sicilia M, Cengiz C. Recent advances in endoscopic management of gastric neoplasms. World J Gastrointest Endosc 2023; 15:319-337. [PMID: 37274561 PMCID: PMC10236974 DOI: 10.4253/wjge.v15.i5.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/12/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
The development and clinical application of new diagnostic endoscopic technologies such as endoscopic ultrasonography with biopsy, magnification endoscopy, and narrow-band imaging, more recently supplemented by artificial intelligence, have enabled wider recognition and detection of various gastric neoplasms including early gastric cancer (EGC) and subepithelial tumors, such as gastrointestinal stromal tumors and neuroendocrine tumors. Over the last decade, the evolution of novel advanced therapeutic endoscopic techniques, such as endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection, along with the advent of a broad array of endoscopic accessories, has provided a promising and yet less invasive strategy for treating gastric neoplasms with the advantage of a reduced need for gastric surgery. Thus, the management algorithms of various gastric tumors in a defined subset of the patient population at low risk of lymph node metastasis and amenable to endoscopic resection, may require revision considering upcoming data given the high success rate of en bloc resection by experienced endoscopists. Moreover, endoscopic surveillance protocols for precancerous gastric lesions will continue to be refined by systematic reviews and meta-analyses of further research. However, the lack of familiarity with subtle endoscopic changes associated with EGC, as well as longer procedural time, evolving resection techniques and tools, a steep learning curve of such high-risk procedures, and lack of coding are issues that do not appeal to many gastroenterologists in the field. This review summarizes recent advances in the endoscopic management of gastric neoplasms, with special emphasis on diagnostic and therapeutic methods and their future prospects.
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Affiliation(s)
- Hira Imad Cheema
- Department of Internal Medicine, Baptist Health Medical Center, Little Rock, AR 72205, United States
| | - Benjamin Tharian
- Department of Interventional Endoscopy/Gastroenterology, Bayfront Health, Digestive Health Institute, St. Petersberg, FL 33701, United States
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Mauricio Garcia-Saenz-de-Sicilia
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Cem Cengiz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205, United States
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, TOBB University of Economics and Technology, Ankara 06510, Turkey
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Vedantam S, Shah R, Bhalla S, Kumar S, Amin S. No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis. Clin Endosc 2023; 56:298-307. [PMID: 37259242 DOI: 10.5946/ce.2022.299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/10/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND/AIMS We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction. METHODS Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed. RESULTS Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%-95.2%) and 92.1% (95% CI, 68.4%-98.4%), clinical success rates of 88.6% (95% CI, 85.4%-91.1%) and 89.6% (95% CI, 79.0%-95.1%), adverse event rates of 11.4% (95% CI, 8.1%-15.9%) and 14.7% (95% CI, 4.4%-39.1%), and reintervention rates of 10.3% (95% CI, 6.7%-15.4%) and 3.5% (95% CI, 1.6%-7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40-9.18; p=0.008). CONCLUSION No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent.
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Affiliation(s)
- Shyam Vedantam
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Rahil Shah
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Sean Bhalla
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - Shria Kumar
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA
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Ito T, Shimatani M, Masuda M, Nakamaru K, Mitsuyama T, Fukata N, Ikeura T, Takaoka M, Okazaki K, Naganuma M. Efficacy and safety of endoscopic stent placement for afferent loop obstruction using a short double‐balloon endoscopy. DEN OPEN 2023; 3:e154. [PMID: 35898829 PMCID: PMC9307746 DOI: 10.1002/deo2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/06/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Takashi Ito
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Masaaki Shimatani
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
- Division of Gastroenterology and Hepatology Kansai Medical University Medical Center Osaka Japan
| | - Masataka Masuda
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Koh Nakamaru
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Toshiyuki Mitsuyama
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
- Division of Gastroenterology and Hepatology Kansai Medical University Medical Center Osaka Japan
| | - Norimasa Fukata
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Tsukasa Ikeura
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Makoto Takaoka
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Kazuichi Okazaki
- Department of Internal Medicine Kansai Medical University Kori Hospital Osaka Osaka Japan
| | - Makoto Naganuma
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
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Peng D, Zhang B, Yuan C, Tong Y, Zhang W. Gastric transcatheter chemoembolization can resolve advanced gastric cancer presenting with obstruction. Front Surg 2022; 9:1004064. [PMID: 36338629 PMCID: PMC9630549 DOI: 10.3389/fsurg.2022.1004064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background Gastric transcatheter chemoembolization (GTC) is an interventional minimal invasive method, which has never been mentioned in the previous literature for advanced gastric cancer with obstruction. The purpose of this study was to evaluate its safety and efficacy in treating advanced gastric cancer with obstruction. Methods Advanced gastric cancer patients with obstruction who underwent GTC were retrospectively analysed from June 2017 to January 2020. Baseline information, peri-intervention data, and post-intervention follow-up information were collected. Clinical data obtained before and after the GTC were compared, and the survival of all patients was analysed. Result Forty-Two patients were included in this study. 42 (100%) patients achieved technical success, and 22 (52.4%) achieved clinical success. The median time of the GTC was 83 (30.0–180.0) minutes, and the median time of hospitalization after GTC was 3 (1–6) days. One patient experienced abdominal pain during and after GTC. Twenty (47.6%) of the 42 patients underwent gastrectomy after intervention. The pre-intervention gastric outlet obstruction scoring system (GOOSS) was 1 (0–1) and the post-intervention GOOSS was 2 (0–3) (p = 0.000 < 0.05). The median follow-up time was 9.5 (3–35) months, and the overall survival time was 14 months. In the univariate survival analysis, a significant difference was observed between patients who did or did not undergo radical gastrectomy after GTC (p = 0.014 < 0.05). Conclusions GTC is a safe and effective treatment, and furthermore, it could be an alternative method in treating advanced gastric cancer with obstruction.
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Khamar J, Lee Y, Sachdeva A, Anpalagan T, McKechnie T, Eskicioglu C, Agzarian J, Doumouras A, Hong D. Gastrojejunostomy versus endoscopic stenting for the palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis. Surg Endosc 2022:10.1007/s00464-022-09572-5. [PMID: 36138247 DOI: 10.1007/s00464-022-09572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Though gastrojejunostomy (GJ) has been a standard palliative procedure for gastric outlet obstruction (GOO), endoscopic stenting (ES) has shown to provide benefits due to its non-invasive approach. The aim of this review is to perform a comprehensive evaluation of ES versus GJ for the palliation of malignant GOO. METHODS MEDLINE, Embase, and CENTRAL databases were searched and comparative studies of adult GOO patients undergoing ES or GJ were eligible for inclusion. The primary outcomes were survival time and mortality. Secondary outcomes included technical success, clinical success, reinterventions, days until oral food tolerance, postoperative adjuvant palliative chemotherapy, postoperative morbidities, length of stay (LOS), and costs. Pairwise meta-analyses using inverse-variance random effects were performed. RESULTS After identifying 2222 citations, 39 full-text articles fit the inclusion criteria. In total, 3128 ES patients (41.4% female, age: 68.0 years) and 2116 GJ patients (40.4% female, age: 66.8 years) were included. ES patients experienced a shorter survival time (mean difference -24.77 days, 95% Cl - 45.11 to - 4.43, p = 0.02) and were less likely to undergo adjuvant palliative chemotherapy (risk ratio 0.81, 95% Cl 0.70 to 0.93, p = 0.004). The ES group had a shorter LOS, shorter time to oral intake of liquids and solids, and less surgical site infections (risk ratio 0.30, 95% Cl 0.12 to 0.75, p = 0.01). The patients in the ES group were at greater risk of requiring reintervention (risk ratio 2.60, 95% Cl 1.87 to 3.63, p < 0.001). CONCLUSION ES results in less postoperative morbidity and shorter LOS when compared to GJ, however, this may be at the cost of decreased initiation of adjuvant palliative chemotherapy and overall survival, as well as increased risk of reintervention. Both techniques are likely appropriate in select clinical scenarios.
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Affiliation(s)
- Jigish Khamar
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, Room G814, 50 Charlton Ave. East, Hamilton, ON, Canada
| | - Anjali Sachdeva
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Tharani Anpalagan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, Room G814, 50 Charlton Ave. East, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, Room G814, 50 Charlton Ave. East, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - John Agzarian
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, Room G814, 50 Charlton Ave. East, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, Room G814, 50 Charlton Ave. East, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, Room G814, 50 Charlton Ave. East, Hamilton, ON, Canada. .,Department of Surgery, McMaster University, Hamilton, ON, Canada.
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Hong J, Chen Y, Li J, Hu P, Chen P, Du N, Huang T, Chen J. Comparison of gastrojejunostomy to endoscopic stenting for gastric outlet obstruction: An updated Systematic Review and Meta-analysis. Am J Surg 2022; 223:1067-1078. [PMID: 34728070 DOI: 10.1016/j.amjsurg.2021.10.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/06/2021] [Accepted: 10/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to determine the optimal intervention modality for malignant GOO by comparing clinical outcomes after Gastrojejunostomy and endoscopic stenting. METHODS Two authors independently searched Web of Science, PubMed, Embase, and the Cochrane Library for articles before February 2021 to compare the clinical outcomes of GOO patients undergoing GJ or ES. RESULTS This meta-analysis included 31 articles with 2444 GOO patients. Although the GJ group outperformed the ES group in technical success (OR,3.79; P = 0.003), clinical success was not significantly different between the two groups (OR,1.25; P = 0.50). The GJ group had a longer hospitalization, lower re-obstruction and lower reintervention. Moreover, GJ had a better survival than ES in the gastric cancer group (HR, 0.33; P = 0.009). However, no significant statistical difference was observed in the pancreatic cancer group (HR, 0.55; P = 0.159). CONCLUSIONS Both GJ and ES are safe and effective intervention modalities for malignant GOO. GJ had significantly improved survival in gastric cancer patients with GOO, while no significant difference was observed between the two groups in pancreatic cancer patients with GOO.
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Affiliation(s)
- Jiaze Hong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Yizhou Chen
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China.
| | - Jiayu Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Peidong Hu
- Schools of Medicine & Nursing Sciences, Huzhou University, Huzhou, Zhejiang, China.
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
| | - Nannan Du
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Tongmin Huang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Jingjie Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
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Outcomes of patients with malignant duodenal obstruction after receiving self-expandable metallic stents: A single center experience. PLoS One 2022; 17:e0268920. [PMID: 35613143 PMCID: PMC9132295 DOI: 10.1371/journal.pone.0268920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/10/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives
Self-expandable metallic stent (SEMS) placement is a safe and effective palliative treatment for malignant gastric outlet obstruction; however, the clinical outcomes of gastric and duodenal stenoses may differ. This study aimed to investigate the clinical efficacy of SEMS placement and the predictors of clinical outcomes, specifically in malignant duodenal obstruction (MDO).
Methods
Between September 2009 and March 2021, 79 patients with MDO who received SEMS placement in our hospital were retrospectively enrolled. Patients were divided into three groups according to the obstruction levels: above-papilla group (type 1), papilla involved group (type 2), and below-papilla group (type 3). The clinical outcomes and predictors of survival and restenosis were analyzed.
Results
The technical and clinical success rates were 97.5% and 80.5%, respectively. Among patients who had successful stent placement, stent restenosis occurred in 17 patients (22.1%). The overall median stent patency time was 103 days. The overall median survival time after stent placement was 116 days. There was no difference in the stent patency, or stent dysfunction and procedure-related adverse events among the three groups. A longer length of duodenal stenosis ≥ 4 cm was associated with poor prognosis (hazard ratio [HR] = 1.92, 95% confidence interval [CI] = 1.06–3.49, p = 0.032) and post-stent chemotherapy was associated with lower mortality (HR = 0.33; 95% CI = 0.17–0.63, p = 0.001).
Conclusion
SEMS is a safe and effective treatment for MDO. Chemotherapy after SEMS implantation improve the survival for these patients and a longer length of stenosis predicts higher mortality.
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Campana LG, Fish R, Dickinson OT, McNamara MG, O'Dwyer ST, Laasch HU. Distal migration of a partially covered duodenal stent requiring emergency surgical extraction. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii210044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luca Giovanni Campana
- Department of Surgery, Colorectal and Peritoneal Oncology Centre (CPOC), The Christie NHS Foundation Trust, Manchester, UK
| | - Rebecca Fish
- Department of Surgery, Colorectal and Peritoneal Oncology Centre (CPOC), The Christie NHS Foundation Trust, Manchester, UK
| | | | - Mairéad Geraldine McNamara
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Theresa O'Dwyer
- Department of Surgery, Colorectal and Peritoneal Oncology Centre (CPOC), The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Hans-Ulrich Laasch
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
- Minnova Medical Foundation CIC, Wilmslow, UK
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Sun Z, Jiang Y, Chen C, Zheng H, Huang W, Xu B, Tang W, Yuan Q, Zhou K, Liang X, Chen H, Han Z, Feng H, Yu S, Hu Y, Yu J, Zhou Z, Wang W, Xu Y, Li G. Radiomics signature based on computed tomography images for the preoperative prediction of lymph node metastasis at individual stations in gastric cancer: A multicenter study. Radiother Oncol 2021; 165:179-190. [PMID: 34774652 DOI: 10.1016/j.radonc.2021.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 10/19/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Specific diagnosis and treatment of gastric cancer (GC) require accurate preoperative predictions of lymph node metastasis (LNM) at individual stations, such as estimating the extent of lymph node dissection. This study aimed to develop a radiomics signature based on preoperative computed tomography (CT) images, for predicting the LNM status at each individual station. METHODS We enrolled 1506 GC patients retrospectively from two centers as training (531) and external (975) validation cohorts, and recruited 112 patients prospectively from a single center as prospective validation cohort. Radiomics features were extracted from preoperative CT images and integrated with clinical characteristics to construct nomograms for LNM prediction at individual lymph node stations. Performance of the nomograms was assessed through calibration, discrimination and clinical usefulness. RESULTS In training, external and prospective validation cohorts, radiomics signature was significantly associated with LNM status. Moreover, radiomics signature was an independent predictor of LNM status in the multivariable logistic regression analysis. The radiomics nomograms revealed good prediction performances, with AUCs of 0.716-0.871 in the training cohort, 0.678-0.768 in the external validation cohort and 0.700-0.841 in the prospective validation cohort for 12 nodal stations. The nomograms demonstrated a significant agreement between the actual probability and predictive probability in calibration curves. Decision curve analysis showed that nomograms had better net benefit than clinicopathologic characteristics. CONCLUSION Radiomics nomograms for individual lymph node stations presented good prediction accuracy, which could provide important information for individual diagnosis and treatment of gastric cancer.
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Affiliation(s)
- Zepang Sun
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yuming Jiang
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Chuanli Chen
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huan Zheng
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weicai Huang
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | | | - Weijing Tang
- Department of Pathology, Stanford University School of Medicine, USA
| | - Qingyu Yuan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kangneng Zhou
- School of Computer and Communication Engineering, University of Science and Technology Beijing, China
| | - Xiaokun Liang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen Colleges of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Hao Chen
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhen Han
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hao Feng
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shitong Yu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiang Yu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhiwei Zhou
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Wei Wang
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Guoxin Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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13
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Chandan S, Khan SR, Mohan BP, Shah AR, Bilal M, Ramai D, Bhogal N, Dhindsa B, Kassab LL, Singh S, Ponnada S, Nguyen AK, McDonough S, Adler DG. EUS-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: Systematic review and meta-analysis. Endosc Int Open 2021; 9:E496-E504. [PMID: 33655056 PMCID: PMC7899789 DOI: 10.1055/a-1341-0788] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic and surgical techniques have been utilized for palliation of gastric outlet obstruction (GOO). Enteral stenting (ES) is an established technique with high clinical success and low morbidity rate. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel approach that aims to provide sustained palliation of GOO. We conducted a comprehensive review and meta-analysis to evaluate the effectiveness in terms of clinical and technical success, as well as the safety profile of EUS-GE and ES. Methods We searched multiple databases from inception through July 2020 to identify studies that reported on safety and effectiveness of EUS-GE in comparison to ES. Pooled rates of technical success, clinical success, and adverse events (AEs) were calculated. Study heterogeneity was assessed using I 2 % and 95 % confidence interval. Results Five studies including 659 patients were included in our final analysis. Pooled rate of technical and clinical success for EUS-GE was 95.2 % (CI 87.2-.98.3, I 2 = 42) and 93.3 % (CI 84.4-97.3, I 2 = 59) while for ES it was 96.9 % (CI 90.9-99, I 2 = 64) and 85.6 % (CI 73-92.9, I 2 = 85), respectively. Pooled rate of re-intervention was significantly lower with EUS-GE i. e. 4 % (CI 1.8-8.7, I 2 = 35) compared to ES, where it was 23.6 % (CI 17.5-31, I 2 = 35), p = 0.001 . Pooled rates of overall and major AEs were comparable between the two techniques. Conclusion EUS-GE is comparable in terms of technical and clinical effectiveness and has a similar safety profile when compared to ES for palliation of GOO.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Shahab R. Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA.
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Aun R. Shah
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States
| | - Mohammad Bilal
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Daryl Ramai
- Internal Medicine, The Brooklyn Hospital Center, New York, United States
| | - Neil Bhogal
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States
| | - Banreet Dhindsa
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Shailendra Singh
- Department of Medicine, West Virginia University Charleston Division, Charleston, West Virginia, United States
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States
| | - Andrew K. Nguyen
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Stephanie McDonough
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
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14
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Jue TL, Storm AC, Naveed M, Fishman DS, Qumseya BJ, McRee AJ, Truty MJ, Khashab MA, Agrawal D, Al-Haddad M, Amateau SK, Buxbaum JL, Calderwood AH, DeWitt J, DiMaio CJ, Fujii-Lau LL, Gurudu SR, Jamil LH, Kwon RS, Law JK, Lee JK, Pawa S, Sawhney MS, Thosani NC, Yang J, Wani SB. ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction. Gastrointest Endosc 2021; 93:309-322.e4. [PMID: 33168194 DOI: 10.1016/j.gie.2020.07.063] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 02/08/2023]
Abstract
This American Society for Gastrointestinal Endoscopy guideline provides evidence-based recommendations for the endoscopic management of gastric outlet obstruction (GOO). We applied the Grading of Recommendations, Assessment, Development and Evaluation methodology to address key clinical questions. These include the comparison of (1) surgical gastrojejunostomy to the placement of self-expandable metallic stents (SEMS) for malignant GOO, (2) covered versus uncovered SEMS for malignant GOO, and (3) endoscopic and surgical interventions for the management of benign GOO. Recommendations provided in this document were founded on the certainty of the evidence, balance of benefits and harms, considerations of patient and caregiver preferences, resource utilization, and cost-effectiveness.
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Affiliation(s)
- Terry L Jue
- Department of Gastroenterology, The Permanente Medical Group, San Francisco, California, USA
| | - Andrew C Storm
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mariam Naveed
- Advent Health Medical Group, Gastroenterology/Hepatology, Advent Health Hospital Altamonte Springs, Altamonte Springs, Florida, USA
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Autumn J McRee
- Division of Hematology/Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Mark J Truty
- Department of Surgical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deepak Agrawal
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Mohammed Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stuart K Amateau
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Audrey H Calderwood
- Department of Gastroenterology and Hepatology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - John DeWitt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Larissa L Fujii-Lau
- Department of Gastroenterology, The Queen's Medical Center, Honolulu, Hawaii, USA
| | - Suryakanth R Gurudu
- Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Laith H Jamil
- Section of Gastroenterology and Hepatology, Beaumont Health, Royal Oak, Michigan, USA
| | - Richard S Kwon
- Department of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Joanna K Law
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jeffrey K Lee
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Swati Pawa
- Department of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav C Thosani
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Julie Yang
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sachin B Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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15
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Jeong SJ, Lee J. Management of gastric outlet obstruction: Focusing on endoscopic approach. World J Gastrointest Pharmacol Ther 2020; 11:8-16. [PMID: 32550041 PMCID: PMC7288729 DOI: 10.4292/wjgpt.v11.i2.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
Gastric outlet obstruction (GOO) is a medical condition characterized by epigastric pain and postprandial vomiting due to mechanical obstruction. The obstructions typically involved in GOO can be benign or malignant. Peptic ulcer disease is the most common cause of benign GOO, and malignant causes include gastric cancer, lymphoma, and gastrointestinal stromal tumor. With the eradication of Helicobacter pylori (H. pylori) and the use of proton pump inhibitors, the predominant causes have changed from benign to malignant diseases. Treatment of GOO depends on the underlying cause: Proton pump inhibitors, H. pylori eradication, endoscopic treatments including balloon dilatation or the placement of self-expandable stents, or surgery.
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Affiliation(s)
- Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan 48108, South Korea
| | - Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan 48108, South Korea
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16
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Mo JW, Kim YM, Kim JH, Shin SY, Youn YH, Park H. Clinical outcomes after multiple self-expandable metallic stent placement using stent-in-stent technique for malignant gastric outlet obstruction. Medicine (Baltimore) 2020; 99:e19432. [PMID: 32481247 PMCID: PMC7249911 DOI: 10.1097/md.0000000000019432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 01/16/2023] Open
Abstract
Self-expandable metallic stent (SEMS) placement is widely used for relieving symptoms in malignant gastric outlet obstruction (MGOO). This study aimed to evaluate the efficacy and safety of multiple gastroduodenal stent placement using the stent-in-stent technique and to identify factors predictive of stent patency.We retrospectively analyzed data from 170 patients with GOO receiving SEMS using the stent-in-stent technique between July 2006 and July 2018. Of these, 90 had been treated with SEMS placement for MGOO. Technical and clinical success rates were evaluated. Clinical outcomes and predictors of stent patency were also analyzed.Second SEMS placement was used in 34.4% of cases and 9.7% were treated with third SEMS placement because of prior stent dysfunction. Median stent patency time was 15.7 weeks for the first SEMS, 10.4 weeks for the second, and 11.3 weeks for the third. The technical and clinical success rates were 100% and 97.8% for the first SEMS, 100% and 90.3% for the second, respectively, and both 100% for the third. Multivariable analysis showed that use of covered SEMS and chemotherapy after first and second SEMS placement was significant predictors of stent patency. Serious complications such as bleeding or perforation did not occur in any patient.Second and third gastroduodenal SEMS placement using the stent-in-stent technique is safe and effective for management of first stent dysfunction in MGOO. Stent patency is significantly associated with the use of covered SEMS and chemotherapy after SEMS placement.
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17
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Yartsev P, Kirsanov I, Teterin Y, Dmitriev I, Lebedev A, Kazakova V. Endoscopic treatment of perforated duodenal ulcer using a partially polyurethane-covered self-expandable nitinol stent: A case report. Asian J Endosc Surg 2020; 13:103-106. [PMID: 30843334 DOI: 10.1111/ases.12697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/06/2018] [Accepted: 01/22/2019] [Indexed: 11/30/2022]
Abstract
We describe a clinical case involving endoscopic treatment of a perforated duodenal ulcer using a partially polyurethane-covered self-expandable nitinol stent. A 93-year-old patient with severe cardiovascular comorbidity underwent a laparoscopic closure of a perforated duodenal ulcer. The early postoperative period was complicated by failure of the closure, and as a result, endoscopic treatment was performed, including the placement of a partially polyurethane-covered self-expandable nitinol stent. The treatment had a positive effect. Further study of the proposed method is required, and favorable results will allow endoscopists to actively introduce this procedure into clinical practice.
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Affiliation(s)
- Peter Yartsev
- Department of Urgent Abdominal Surgery, Endoscopy and Intensive Therapy, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Ilya Kirsanov
- Department of Urgent Abdominal Surgery, Endoscopy and Intensive Therapy, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Yury Teterin
- Department of Urgent Abdominal Surgery, Endoscopy and Intensive Therapy, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Ilya Dmitriev
- Department of Pancreas and Kidney Transplantation, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Aleksander Lebedev
- Department of Urgent Abdominal Surgery, Endoscopy and Intensive Therapy, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Victoria Kazakova
- Department of Urgent Abdominal Surgery, Endoscopy and Intensive Therapy, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
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18
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Kwon CI. [Relief of Obstruction in the Management of Pancreatic Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 74:69-80. [PMID: 31438658 DOI: 10.4166/kjg.2019.74.2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 11/03/2022]
Abstract
Pancreatic cancer is a major cause of cancer-related mortality and morbidity, and its incidence is increasing as the population is aging. On the other hand, significant improvement in the prognosis has not occurred. The absence of early diagnosis means that many patients are diagnosed only when they develop symptoms, such as jaundice, due to a biliary obstruction. The role of endoscopy in multidisciplinary care for patients with pancreatic cancer continues to evolve. Controversy remains regarding the best preoperative biliary drainage in patients with surgically resectable pancreatic head cancer. In general, patients undergoing a surgical resection usually do not require preoperative biliary drainage unless they have cholangitis or receive neoadjuvant chemotherapy. If biliary drainage is performed prior to surgery, the patient's condition and a multidisciplinary approach should be considered. With the increasing life expectancy of patients with pancreatic cancer, the need for more long-time biliary drainage or pre-operative biliary drainage is also increasing. Strong evidence of endoscopic retrograde cholangiopancreatography (ERCP) as a first-line and essential treatment for biliary decompression has been provided. On the other hand, the use of endoscopic ultrasound-guided biliary drainage as well as percutaneous biliary drainage has been also recommended. During ERCP, self-expandable metal stent could be recommended instead of a plastic stent for the purpose of long stent patency and minimizing stent-induced complications. In this review, several points of view regarding the relief of obstruction in patients with pancreatic cancer, and optimal techniques are being discussed.
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Affiliation(s)
- Chang-Il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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19
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Shen Z, Yu J, Tang H, Lu B. Closed Loop Duodenal Obstruction Secondary to Pancreatic Carcinoma: A Case Report. Comb Chem High Throughput Screen 2019; 22:280-286. [PMID: 30973103 DOI: 10.2174/1386207322666190411112412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/30/2018] [Accepted: 12/11/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with pancreatic adenocarcinoma may develop into duodenal obstruction during the course of their disease. The diagnosis of obstruction can be generally achieved by means of imaging technologies. Case and Outcome We reported a rare case of pancreatic tumor with duodenal obstruction accompanied by obstructive symptoms, which was finally confirmed by laparotomy. A 68-year-old man was admitted to our department with a 3-day medical history of upper abdominal pain, nausea and vomiting. The diagnosis of duodenal obstruction was established by means of various imagings including computed tomography (CT) scan, gastroscopy and upper gastrointestinal imaging. Upper gastrointestinal imaging and magnetic resonance imaging (MRI) showed extrinsic tumor mass was noted at the second and third portion of the duodenum accompanied by duodenal obstruction and dilatation, respectively. Laparotomy confirmed a tumor mass arising from the head and uncinate process of pancreas, which had invaded the second and third portions of the duodenum and caused closed loop obstruction. A pancreaticoduodenectomy (Whipple procedure) was performed followed by therapeutic trade-off according to intraoperative exploration. Postoperative histopathology revealed pancreatic tumor only infiltrated duodenal wall, while resection margins of pancreas, common bile duct and duodenum were all negative. The patient was cured and discharged home 12 days after surgery. CONCLUSION The present case indicated radical operation in our study appeared to be the first choice treatment for patients with malignant duodenal obstruction.
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Affiliation(s)
- Zhihong Shen
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing University, Shaoxing 312000, China
| | - Jianhua Yu
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing University, Shaoxing 312000, China
| | - Haijun Tang
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing University, Shaoxing 312000, China
| | - Baochun Lu
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing University, Shaoxing 312000, China
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20
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Nabi Z, Reddy DN. Endoscopic Management of Combined Biliary and Duodenal Obstruction. Clin Endosc 2019; 52:40-46. [PMID: 30626177 PMCID: PMC6370931 DOI: 10.5946/ce.2018.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/01/2018] [Accepted: 07/12/2018] [Indexed: 12/23/2022] Open
Abstract
Combined obstruction of the bile duct and duodenum is a common occurrence in periampullary malignancies. The obstruction of gastric outlet or duodenum can follow, occur simultaneously, or precede biliary obstruction. The prognosis in patients with combined obstruction is particularly poor. Therefore, minimally invasive palliation is preferred in these patients to avoid morbidity associated with surgery. Endoscopic palliation is preferred to surgical bypass due to similar efficacy, less morbidity, and shorter hospital stay. The success of endoscopic palliation depends on the type of bilioduodenal stenosis and the presence of previously placed duodenal metal stents. Biliary cannulation is difficult in type II bilioduodenal strictures where the duodenal stenosis is located at the level of the papilla. Consequentially, technical and clinical success is lower in these patients than in those with type I and III bilioduodenal strictures. However, in cases with failure of endoscopic retrograde cholangiopancreatography, with the introduction of endoscopic ultrasound for biliary drainage, the success of endoscopic bilioduodenal bypass is likely to increase further. The safety and efficacy of endoscopic ultrasound-guided drainage has been documented in multiple studies. With the development of dedicated accessories and standardization of drainage techniques, the role of endoscopic ultrasound is likely to expand further in cases with double obstruction.
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Affiliation(s)
- Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D. Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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21
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Leiyuan S, Jianli X, Zhengzhong Z, Guangyan J, Dailiang Z. Comparison of Treatment Outcomes of Endoscopic Stenting and Laparoscopic Gastrojejunostomy for Malignant Gastric Outlet Obstruction. Am Surg 2018. [DOI: 10.1177/000313481808400654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To compare the clinic outcomes of endoscopic stenting and laparoscopic gastrojejunostomy (LGJ) for patients with malignant gastric outlet obstruction (GOO). We retrospectively reviewed 63 patients with malignant GOO that underwent endoscopic stenting [Stent Group (SG), n = 29] or LGJ [Laparoscopic Group (LG), n = 34]. Then, we evaluated the medical effects, postoperative hospital stay, and hospitalization expenses in both groups. Compared to LG, SG has a shorter operation time [SG: (41.1 ± 9.3) minutes vs LG: (137.4 ± 21.7) minutes, P = 0.000], less intra-operative blood loss [(23.7 ± 9.0) mL vs (121.1 ± 24.3) mL, P = 0.000], relatively lower hospitalization expenses [(2272.7 ± 413.9) $ vs (5182.4 ± 517.3) $, P = 0.000]. Besides, the median intake time was significantly shorter in the SG than that in the LG [(0.9 ± 0.3) days vs (4.1 ± 0.6) days, P = 0.000]. However, there were no significant differences between SG with LG in surgical success rate (100 vs 100%, P = 1.000), length of hospital stay [(6.1 ± 3.3) days vs (10.9 ± 4.7) days, P = 0.422], recurrent obstructive rate (37.9 vs 26.5%, P = 0.949) and median survivals [(141.4 ± 81.4) days vs (122.7 ± 88.8) days, P = 0.879]. Endoscopic stenting and LGJ are both relatively safe and effective treatments for patients with malignant GOO. But we suggest that endoscopic stenting should be considered first in patients with malignant GOO because it has many advantages over LGJ.
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Affiliation(s)
- Shuai Leiyuan
- Department of General Surgery, Jiangjin Central Hospital of Chongqing, Chongqing, China
| | - Xu Jianli
- Department of General Surgery, Jiangjin Central Hospital of Chongqing, Chongqing, China
| | - Zhao Zhengzhong
- Department of Endoscopic Treatment Center, Jiangjin Central Hospital of Chongqing, Chongqing, China
| | - Ji Guangyan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhu Dailiang
- Department of General Surgery, Jiangjin Central Hospital of Chongqing, Chongqing, China
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22
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Yukimoto T, Morisaki T, Komukai S, Yoshida H, Yamaguchi D, Tsuruoka N, Miyahara K, Sakata Y, Shibasaki S, Tsunada S, Noda T, Yunotani S, Fujimoto K. The Palliative Effect of Endoscopic Uncovered Self-expandable Metallic Stent Placement Versus Gastrojejunostomy on Malignant Gastric Outlet Obstruction: A Pilot Study with a Retrospective Chart Review in Saga, Japan. Intern Med 2018; 57:1517-1521. [PMID: 29434131 PMCID: PMC6028667 DOI: 10.2169/internalmedicine.0171-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective Endoscopic self-expandable metallic stent (SEMS) placement and gastrojejunostomy (GJY) are palliative treatments for malignant gastric outlet obstruction (GOO). The aim of the present study was to compare the palliative effects of these treatments and identify predictors of a poor oral intake after treatment. Methods and Patients In total, 65 patients with GOO at multiple centers in Saga, Japan, were evaluated. Thirty-eight patients underwent SEMS placement, and 27 underwent GJY from January 2010 to December 2016. The characteristics and outcomes of the two groups were compared to detect predictors of treatment failure. Results No significant differences in the technical success, clinical success, post-treatment total protein, hospital discharge, duration from eating disability to death, or post-treatment overall survival were present between the SEMS and GJY groups. More patients in the GJY group than in the SEMS group received chemotherapy (51.4% vs. 26.3%, respectively; p=0.042). The period from treatment to the first meal was longer in the GJY group than in the SEMS group (4.5 vs. 3.0 days, respectively; p=0.013). The present study did not identify any risk factors for failure of SEMS placement. Although the stent length tended to be associated with a poor prognosis, the correlation was not statistically significant (odds ratio: 0.60, 95% confidence interval: 0.36-1.01, p=0.053). Conclusion Patients with GOO started meals more promptly after SEMS than after GJY, but the clinical outcomes were not markedly different between the SEMS and GJY groups. These findings suggest that endoscopic uncovered SEMS placement might be a feasible palliative treatment for GOO.
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Affiliation(s)
- Takahiro Yukimoto
- Departments of Gastroenterology, National Hospital Organization Ureshino Medical Center, Japan
- Department of Internal Medicine, Saga Medical School, Japan
| | - Tomohito Morisaki
- Departments of Gastroenterology, National Hospital Organization Ureshino Medical Center, Japan
| | - Sho Komukai
- Department of Clinical Research Center, Saga Medical School, Japan
| | - Hisako Yoshida
- Department of Clinical Research Center, Saga Medical School, Japan
| | - Daisuke Yamaguchi
- Departments of Gastroenterology, National Hospital Organization Ureshino Medical Center, Japan
| | - Nanae Tsuruoka
- Department of Internal Medicine, Saga Medical School, Japan
| | - Koichi Miyahara
- Departments of Gastroenterology, Karatsu Red Cross Hospital, Japan
| | | | - Shinichi Shibasaki
- Departments of Surgery, National Hospital Organization Ureshino Medical Center, Japan
| | - Seiji Tsunada
- Departments of Gastroenterology, National Hospital Organization Ureshino Medical Center, Japan
| | - Takahiro Noda
- Departments of Gastroenterology, Karatsu Red Cross Hospital, Japan
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23
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Upchurch E, Ragusa M, Cirocchi R. Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction. Cochrane Database Syst Rev 2018; 5:CD012506. [PMID: 29845610 PMCID: PMC6494580 DOI: 10.1002/14651858.cd012506.pub2] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malignant gastric outlet obstruction is the clinical and pathological consequence of cancerous disease causing a mechanical obstruction to gastric emptying. It usually occurs when malignancy is at an advanced stage; therefore, people have a limited life expectancy. It is of paramount importance to restore oral intake to improve quality of life for the person in a manner that has a minimal risk of complications and a short recovery period. OBJECTIVES To assess the benefits and harms of endoscopic stent placement versus surgical palliation for people with symptomatic malignant gastric outlet obstruction. SEARCH METHODS In May 2018 we searched the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase and Ovid CINAHL. We screened reference lists from included studies and review articles. SELECTION CRITERIA We included randomised controlled trials comparing stent placement with surgical palliation for people with gastric outlet obstruction secondary to malignant disease. DATA COLLECTION AND ANALYSIS Two review authors independently extracted study data. We calculated the risk ratio (RR) with 95% confidence intervals (CI) for binary outcomes, mean difference (MD) or standardised mean difference (SMD) with 95% CI for continuous outcomes and the hazard ratio (HR) for time-to-event outcomes. We performed meta-analyses where meaningful. We assessed the quality of evidence using GRADE criteria. MAIN RESULTS We identified three randomised controlled trials with 84 participants. Forty-one participants underwent surgical palliation and 43 participants underwent duodenal stent placement. There may have been little or no difference in the technical success of the procedure (RR 0.98, 95% CI 0.88 to 1.09; low-quality evidence), or whether the time to resumption of oral intake was quicker for participants who had undergone duodenal stent placement (MD -3.07 days, 95% CI -4.76 to -1.39; low-quality evidence).Due to very low-quality evidence, we were uncertain whether surgical palliation improved all-cause mortality and median survival postintervention.The time to recurrence of obstructive symptoms may have increased slightly following duodenal stenting (RR 5.08, 95% CI 0.96 to 26.74; moderate-quality evidence).Due to very low-quality evidence, we were uncertain whether surgical palliation improved serious and minor adverse events. The heterogeneity for adverse events was moderately high (serious adverse events: Chi² = 1.71; minor adverse events: Chi² = 3.08), reflecting the differences in definitions used and therefore, may have impacted the outcomes. The need for reintervention may have increased following duodenal stenting (RR 4.71, 95% CI 1.36 to 16.30; very low-quality evidence).The length of hospital stay may have been shorter (by approximately 4 to 10 days) following stenting (MD -6.70 days, 95% CI -9.41 to -3.98; moderate-quality evidence). AUTHORS' CONCLUSIONS The use of duodenal stent placement in malignant gastric outlet obstruction has the benefits of a quicker resumption of oral intake and a reduced inpatient hospital stay; however, this is balanced by an increase in the recurrence of symptoms and the need for further intervention.It is impossible to draw further conclusions on these and the other measured outcomes, primarily due to the low number of eligible studies and small number of participants which resulted in low-quality evidence. It was not possible to analyse the impact on quality of life each intervention had for these participants.
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Affiliation(s)
- Emma Upchurch
- Gloucestershire Hospitals NHS Foundation TrustDepartment of Colorectal and Upper Gastrointestinal SurgerySandford RoadCheltenhamGloucestershireUKGL53 7AN
| | | | - Roberto Cirocchi
- University of PerugiaDepartment of General SurgeryTerniItaly05100
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Bulut E, Çiftçi T, Akhan O, Akıncı D. Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches. Diagn Interv Radiol 2018; 23:211-216. [PMID: 28209556 DOI: 10.5152/dir.2016.16165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE We aimed to evaluate the safety and effectiveness of fluoroscopy-guided gastroduodenal metallic stent placement with different approaches in malignant obstruction. METHODS We retrospectively assessed 53 patients (33 men and 20 women; mean age, 58.7±15 years) who underwent stent placement between February 2004 and April 2014. All patients had unresectable tumors. The most common causes of obstruction were gastric (38%) and pancreatic cancers (36%). Uncovered self-expandable metallic stents (SEMS) were placed under fluoroscopic guidance. In addition to transoral approach in 46 patients (86.7%), transgastric and transhepatic approaches were used in six patients (11.3%) and one patient (1.8%), respectively. Gastric outlet obstruction scoring system (GOOSS) was used to evaluate oral intake before and after stenting. Patients were followed until death or the end of the study. RESULTS Technical and clinical success rates were 100% and 92%, respectively. The median stent patency was 76 days (range, 4-985 days). Mean preprocedural GOOSS score of 0.1 increased to postprocedural GOOSS score of 2.42 (P < 0.001). Afferent loop decompression was achieved in one symptomatic patient. Neither mortality nor major complications occurred due to stenting. Stent migration occurred in one patient (2%) and stent obstruction occurred in two patients (4%). Combined biliary and duodenal stenting were performed in 21 patients (40%). Post-stenting GOOSS scores were predictive of survival (P = 0.003). CONCLUSION Fluoroscopic metallic stent placement for palliation of malignant gastroduodenal obstruction is safe and effective with high technical and clinical success rates and minimal complications. High technical success rates can be achieved using different approaches.
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Affiliation(s)
- Elif Bulut
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
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25
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Supportive care in pancreatic ductal adenocarcinoma. Clin Transl Oncol 2017; 19:1293-1302. [PMID: 28612201 DOI: 10.1007/s12094-017-1682-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/15/2017] [Indexed: 12/27/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the cancers with poorest prognosis and represents the third leading cause of cancer-related deaths in Western countries. Despite advances in diagnostic procedures and treatment, diagnosis is made in most cases when the disease is locally advanced or metastatic. Supportive care aims to improve symptoms, reduce hospital admission rates, and preserve quality of life. Proper symptomatic management is critical to allow administration of chemotherapy and radiotherapy. Symptomatic management should be accomplished in a multidisciplinary fashion. Its primary aims include relief of biliary or duodenal obstruction, prevention and/or treatment of thromboembolic disease, and control cancer-related pain. Nutritional support and optimal replacement therapy in patients with endocrine and/or exocrine insufficiency, is mandatory. This manuscript highlights the most significant problems faced when caring for patients with advanced PDAC and provides an evidence-based approach to symptomatic management.
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Hamada T, Hakuta R, Takahara N, Sasaki T, Nakai Y, Isayama H, Koike K. Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta-analysis. Dig Endosc 2017; 29:259-271. [PMID: 27997723 DOI: 10.1111/den.12786] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Self-expandable metal stents (SEMS) are used for non-resectable malignant gastric outlet obstruction (GOO). Studies of covered versus uncovered SEMS have yielded inconsistent results as a result of heterogeneity in design and patient population. We carried out a meta-analysis to compare covered and uncovered gastroduodenal SEMS. METHODS Using MEDLINE, Embase, and the Cochrane database, we identified 1624 patients from 13 prospective and retrospective studies that evaluated covered and uncovered SEMS for malignant GOO and were published until October 2016. We pooled data on SEMS dysfunction, technical and clinical success, and adverse events using the fixed-effect or random-effects model. RESULTS Compared with uncovered SEMS, covered SEMS did not show any significant difference in stent dysfunction risk (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.79-1.32). A subgroup analysis of five randomized trials suggested a trend toward a lower dysfunction risk in covered SEMS (RR, 0.63; 95% CI, 0.45-0.88). Covered SEMS were associated with a lower occlusion risk (RR, 0.44; 95% CI, 0.28-0.68), but with a higher migration risk (RR, 4.28; 95% CI, 2.89-6.34). Technical and clinical success rates were comparable between the groups. Overall adverse events tended to be more frequent in covered SEMS (RR, 1.75; 95% CI, 1.09-2.83). CONCLUSIONS Outcomes of covered and uncovered gastroduodenal SEMS were comparable, although the lower dysfunction rate of covered SEMS observed in the analysis of randomized trials needs further investigation. Antimigration mechanisms for covered SEMS and identification of patients who can achieve longer patency from uncovered SEMS would help improve the outcomes of gastroduodenal SEMS.
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Affiliation(s)
- Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokoyo, Japan.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - Ryunosuke Hakuta
- Department of Gastroenterology, Japanese Red Cross Medical Center, Tokoyo, Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokoyo, Japan
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokoyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokoyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokoyo, Japan
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27
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Ye BW, Chou CK, Hsieh YC, Li CP, Chao Y, Hou MC, Lin HC, Lee KC. Metallic Stent Expansion Rate at Day One Predicts Stent Patency in Patients with Gastric Outlet Obstruction. Dig Dis Sci 2017; 62:1286-1294. [PMID: 28315029 DOI: 10.1007/s10620-017-4534-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/08/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Self-expandable metallic stent insertion has been a mainstream treatment for relieving the obstructive symptoms of malignant gastric outlet obstruction (MGOO), a late-stage complication of gastrointestinal malignancies. This study aims to investigate the predictive value of stent expansion rates in clinical outcomes in patients with MGOO. METHODS Eighty-seven patients with inoperable MGOO receiving metallic stents were reviewed retrospectively from April 2010 to December 2014. Clinical outcomes, predictors of stent patency, and survival were analyzed. RESULTS The technical and clinical success rates were 100 and 94.3%, respectively. The median stent patency time was 114 days (range 13-570 days). The median survival time was 133 days (range 13-1145 days). Stent dysfunctions occurred in 28 patients (32.2%), with restenosis accounting for the majority (82%). The stent expansion rate ≥75% at Day 1 predicted the stent patency [hazard ratio (HR) 0.12, P = 0.04]. However, it did not correlate with survival. Non-gastric cancer origins (HR 2.41, P = 0.002) and peritoneal carcinomatosis (HR 2.54, P = 0.001) correlated with poor survival. However, post-stent chemotherapy (HR 0.55, P = 0.03) was related to better outcome. The comparison of clinical outcomes of first and second stent insertions showed no significant difference in the stent expansion rate either at Day 0 and Day 1 (P = 0.97 and P = 0.57). CONCLUSIONS Self-expandable metallic stent insertion is a safe and effective treatment for relieving the obstructive symptoms. The stent expansion rate ≥75% at Day 1 is a novel stent-related predictor of stent patency.
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Affiliation(s)
- Bing-Wei Ye
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chung-Kai Chou
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, National Yang-Ming University Hospital, Ilan, Taiwan
| | - Yun-Cheng Hsieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yee Chao
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Endoscopic Diagnosis and Therapeutic Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Kuei-Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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Shabunin AV, Lebedev SS, Chechenin GM, Barinov YV, Sidorova YV, Bagateliya ZA, Vardanyan AV, Dolidze DD. [Metal self-expanding stents for malignant obstruction of stomach outlet and duodenum]. Khirurgiia (Mosk) 2017:47-50. [PMID: 28805778 DOI: 10.17116/hirurgia2017847-50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To compare different types of self-expanding stents (partially coated or uncovered) for malignant pyloroduodenal obstruction (MPDO). MATERIAL AND METHODS 89 MPDO patients underwent stenting at the Botkin City Hospital (Moscow) for the period 2008-2016. The causes of malignant obstruction were: stomach cancer - 53 (59.5%), pancreatic cancer - 31 (34.8%), compression by retroperitoneal lymph nodes - 3 (3.4%), duodenal cancer - 2 (2.2%). Patients were divided into two homogeneous groups. In group 1 (32 patients) partially coated stents were used, in group 2 (57 patients) - uncovered stents. Mean age was 68.3±6.2 and 64.3±5.7 years in both groups respectively; male/female ratio 18/14 in group 1, 32/25 in group 2. Length of stricture was 51±5.1 mm in group 1, 48±4.8 mm in group 2. GOOSS score in group 1: 0-8, 1-13, 2-11, 3-0, in group 2 0-14, 1-25, 2-18, 3-0 (p=0.03). RESULTS AND DISCUSSION Technical success was achieved in 32 patients of group 1 (100%) and in 57 patients of group 2 (100%). There were no procedure-associated complications and mortality. Clinical success was observed in 29 (90.6%) patients of group 1 and in 50 (87.7%) patients of group 2. GOOSS score of group 1: 0-8, 1-8, 2-10, 3-12, group 2: 0-3, 1-15, 2-19, 3-20. There were 3 distal dislocations of the stent within 1 - days in group 1, in group 2 dislocations were absent. Postoperative chemotherapy was prescribed in 20 (62.5%) patients of group 1 and 38 (66.7%) patients of group 2 (p=0.08). 27 patients of group 1 and 49 patients of group 2 died due to progression of the disease, others are under observation. Mean life expectancy: group 1 (18 patients - 50 days, 9 patients - 100 days, 5 patients were alive by the moment of study); group 2 (32 patients - 50 days, 100 days - 17 patients, 8 patients were alive by the moment of study). 3 patients (9.4%) in group 1 and 7 (12.3%) patients in group 2 had stent dysfunction (p=0.02). Mean period of partially covered stent function was 138±3.9 days, uncovered stent - 96±4.8 days (р=0.003). CONCLUSION Our study showed that time of stent function corresponds to median survival. Greater number of stent migration in group 1 is due to stent coverage, higher incidence of stent dysfunction in group 2 - due to malignant invasion.
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Affiliation(s)
- A V Shabunin
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - S S Lebedev
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - G M Chechenin
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - Yu V Barinov
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - Yu V Sidorova
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - Z A Bagateliya
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - A V Vardanyan
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - D D Dolidze
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
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Minata MK, Bernardo WM, Rocha RSDP, Morita FHA, Aquino JCM, Cheng S, Zilberstein B, Sakai P, de Moura EGH. Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review. Endosc Int Open 2016; 4:E1158-E1170. [PMID: 27857965 PMCID: PMC5111833 DOI: 10.1055/s-0042-115935] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022] Open
Abstract
Background and study aims: Palliative treatment of gastric outlet obstruction can be done with surgical or endoscopic techniques. This systematic review aims to compare surgery and covered and uncovered stent treatments for gastric outlet obstruction (GOO). Patients and methods: Randomized clinical trials were identified in MEDLINE, Embase, Cochrane, LILACs, BVS, SCOPUS and CINAHL databases. Comparison of covered and uncovered stents included: technical success, clinical success, complications, obstruction, migration, bleeding, perforation, stent fracture and reintervention. The outcomes used to compare surgery and stents were technical success, complications, and reintervention. Patency rate could not be included because of lack of uniformity of the extracted data. Results: Eight studies were selected, 3 comparing surgery and stents and 5 comparing covered and uncovered stents.The meta-analysis of surgical and endoscopic stent treatment showed no difference in the technical success and overall number of complications. Stents had higher reintervention rates than surgery (RD: 0.26, 95 % CI [0.05, 0.47], NNH: 4). There is no significant difference in technical success, clinical success, complications, stent fractures, perforation, bleeding and the need for reintervention in the analyses of covered and uncovered stents. There is a higher migration rate in the covered stent therapy compared to uncovered self-expanding metallic stents (SEMS) in the palliation of malignant GOO (RD: 0.09, 95 % CI [0.04, 0.14], NNH: 11). Nevertheless, covered stents had lower obstruction rates (RD: - 0.21, 95 % CI [-0.27, - 0.15], NNT: 5). Conclusions: In the palliation of malignant GOO, covered SEMS had higher migration and lower obstruction rates when compared with uncovered stents. Surgery is associated with lower reintervention rates than stents.
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Affiliation(s)
- Mauricio Kazuyoshi Minata
- University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil,Corresponding author Mauricio Kazuyoshi Minata University of São Paulo Medical SchoolGastrointestinal Endoscopy UnitGastroenterology DepartmentAvenida Dr. Enéas de Carvalho Aguiar, 1556º andar São Paulo SP05013001 Brazil+55112661-0000
| | | | - Rodrigo Silva de Paula Rocha
- University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil
| | - Flavio Hiroshi Ananias Morita
- University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil
| | - Julio Cesar Martins Aquino
- University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil
| | - Spencer Cheng
- University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil
| | - Bruno Zilberstein
- University of São Paulo Medical School, Digestive Surgery, Gastroenterology Department, São Paulo, Brazil
| | - Paulo Sakai
- University of São Paulo Medical School, Gastrointestinal Endoscopy Unit, Gastroenterology Department, São Paulo, Brazil
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Zhu J, Jin Z. Interventional Therapy for Pancreatic Cancer. Gastrointest Tumors 2016; 3:81-89. [PMID: 27904860 DOI: 10.1159/000446800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Palliative therapy and primarily chemoradiotherapy are the mainstream treatments in patients with locally advanced or metastatic pancreatic cancer (PC). Conventional endoscopy and endoscopic ultrasound (EUS)-guided interventional therapy has emerged as an important procedure for PC management. In this review, the progress in conventional endoscopy and EUS for PC management is discussed. SUMMARY For local palliative therapy against PC, EUS-guided fine needle injection (FNI) could deliver different kinds of agents, such as radioactive seeds and fiducials. Although their feasibility and safety have been proven, the long-term efficiency of EUS-FNI is still not established. For pain, EUS-celiac plexus neurolysis (CPN) is effective. However, CPN can only relieve the pain to a limited degree, with short duration. Endoscopy-guided stent placement is the preferred strategy for biliary and duodenal obstruction. Plastic and metal stents are equally effective for the relief of obstructive jaundice. The functional times of metal stents are longer than those of a plastic stent. KEY MESSAGE For biliary obstruction, a metal stent is the first choice. The long-term efficiency of EUS-FNI still needs further study. PRACTICAL IMPLICATIONS Endoscopy and EUS-guided interventions have gradually become the mainstream method for local treatment of PC due to mini-invasiveness and real-time observation. PC is the second most common gastrointestinal malignancy and the sixth leading cause of cancer mortality in the United States, leading to about 4.0% of all cancer deaths [Siegel et al: CA Cancer J Clin 2014;64:9-29]. The only curative approach for patients with PC is surgical resection, but unfortunately 80-90% of patients have a surgically inoperable disease, with 53% having local metastases at the time of diagnosis [Weinberg et al: Oncology (Williston Park) 2015;29:809-820, 886]. Therefore, palliative therapy and primarily chemoradiotherapy are the mainstream of treatment in patients with locally advanced or metastatic PC. Although overall survival has improved from 6 to 8.5-11 months (some of them even survived for a year or more), the overall survival rate has not improved, and the 5-year survival is less than 4% [Weinberg et al: Oncology (Williston Park) 2015;29:809-820, 886; Greenlee et al: CA Cancer J Clin 2001;51:15-36; Zhang et al: Gastroenterol Res Pract 2016;2016:8962321]. Hence, it is crucial to develop more effective local treatment strategies for tumor tissue and symptom palliation. At present, endoscopy has gradually become the mainstream method for local treatment of gastrointestinal cancer due to mini-invasiveness and real-time observation. Conventional endoscopy can be used to manage the complication caused by PC, including endoscopic biliary stent placement for obstructive jaundice, and duodenal stent placement for duodenal obstruction. In addition, in those cases in whom obstructive jaundice failed to be relieved by endoscopic biliary stent placement, EUS-guided biliary drainage has emerged as an alternative procedure. Furthermore, antitumor agents can be delivered into tumor tissue or celiac plexus directly under interventional EUS guided to manage the tumor or the pain caused by the tumor. In this review, the progress in conventional endoscopy and EUS for PC management is discussed.
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Affiliation(s)
- Jianwei Zhu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Kato H, Kawamoto H, Matsumoto K, Moriyama I, Kamada H, Tsutsumi K, Goto D, Fukuba N, Kato K, Sonoyama H, Isomoto H, Okada H. Outcome of self-expandable metallic stent deployment in patients with malignant gastroduodenal outlet obstruction and Niti-S and WallFlex comparison: a multicenter retrospective clinical study. J Dig Dis 2016; 17:518-525. [PMID: 27383654 DOI: 10.1111/1751-2980.12377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/20/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Several studies report on the outcomes of self-expandable metallic stents (SEMSs) deployment for malignant gastric outlet obstruction (GOO). However, data was mostly based on the analysis of single-center studies including only a small number of patients. This study aimed to evaluate clinical outcomes after the deployment of SEMS in patients with malignant GOO and to compare the clinical outcomes of two metallic stents with different designs. METHODS Altogether 125 consecutive patients from five institutions were included. Clinical outcomes were evaluated according to technical success, clinical success, stent patency period, survival period and complications. A comparison of clinical outcomes between Niti-S pyloric/duodenal and WallFlex duodenal stents was also undertaken. RESULTS Rates for clinical and technical success were 100% and 92.0%, respectively. The median stent patency and survival periods were 72.0 days (range 3-775 days) and 75.0 days (range 3-775 days), respectively. The rate of overall adverse events was 28.8%. The rate of stent dysfunction was 16.8%, and that of adverse events, except stent dysfunction was 12.0%. Massive bleeding occurred in two patients as a late complication. The clinical success rate for Niti-S stent was significantly higher than that for WallFlex stent (96.2% vs 84.8%, P = 0.023). CONCLUSIONS We successfully deployed a SEMS in malignant GOO. The selection of a SEMS with a lower axial force may be important for patients to resume the oral food intake. Additionally, consideration must be given to the appropriate management of fatal bleeding as a late complication.
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Affiliation(s)
- Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. .,Hakushusanbi Endoscopic Workshop Group, Japan.
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2, Kawasaki Medical School, Okayama, Japan.,Hakushusanbi Endoscopic Workshop Group, Japan
| | - Kazuya Matsumoto
- Department of Gastroenterology, Tottori University Hospital, Yonago, Japan.,Hakushusanbi Endoscopic Workshop Group, Japan
| | - Ichiro Moriyama
- Division of Clinical study of Oncology, Shimane University School of Medicine, Izumo, Japan.,Hakushusanbi Endoscopic Workshop Group, Japan
| | - Hideki Kamada
- Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan.,Hakushusanbi Endoscopic Workshop Group, Japan
| | - Koichiro Tsutsumi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Daisuke Goto
- Department of Gastroenterology and Hepatology, Tottori Municipal Hospital, Tottori, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Kiyohito Kato
- Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Hajime Isomoto
- Department of Gastroenterology, Tottori University Hospital, Yonago, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Park JH, Song HY, Yun SC, Yoo MW, Ryu MH, Kim JH, Kim DH, Lee JH, Zhou WZ, Yook JH, Jung HY. Gastroduodenal stent placement versus surgical gastrojejunostomy for the palliation of gastric outlet obstructions in patients with unresectable gastric cancer: a propensity score-matched analysis. Eur Radiol 2016; 26:2436-2445. [PMID: 26662027 DOI: 10.1007/s00330-015-4106-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/12/2015] [Accepted: 11/10/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare the outcomes between stent placement and surgical gastrojejunostomy (GJ) for the palliation of gastric outlet obstruction (GOO) in patients with unresectable gastric cancer. METHODS A retrospective study was performed in a single university hospital in 224 patients with GOO, and who were treated either by stent placement (n = 124) or surgical GJ (n = 100). The outcomes were assessed with reference to the following variables with the use of propensity-score matching: success rates; complications; dysphagia scores, albumin, and body mass index; survival; symptom-free duration; and hospitalization. RESULTS We identified a well-balanced cohort of 74 pairs of patients, matched on the basis of propensity score. The dysphagia score 7 days after treatment was significantly better in the stent group (P < 0.001). Albumin level 1 month after treatment was significantly lower in the stent group (P < 0.001). Symptom-free duration and hospitalization were significantly longer in the surgery group (P = 0.002, P < 0.001, respectively). The recurrence rate was significantly higher in the stent group (P = 0.032). CONCLUSIONS Stent placement can provide faster symptom relief and shorter hospitalization, while surgical GJ can provide longer symptom-free duration, less recurrent obstruction symptoms and better nutritional status. KEY POINTS • The two methods are equally effective in palliating gastric outlet obstruction symptoms • The stent group showed rapid and efficient palliation of symptoms • Recurrent symptoms were more frequent in the stent group • Surgical gastrojejunostomy provides a longer symptom-free duration and better nutritional status.
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Affiliation(s)
- Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Moon-Won Yoo
- Department of General Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wei-Zhong Zhou
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jeong Hwan Yook
- Department of General Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Shimizu K, Takamori H, Baba H. Usefulness of surgical closure following intraoperative endoscopic additional stenting of duodenal perforation by stent: Report of a case. Int J Surg Case Rep 2016; 25:21-3. [PMID: 27289171 PMCID: PMC4908309 DOI: 10.1016/j.ijscr.2016.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 12/02/2022] Open
Abstract
Perforation of duodenum rarely occurs after stenting, but it could be life threatening. Reduced the force of the existing stent to the injury site, which could make it possible to perform simple closure. Surgical closure following intraoperative endoscopic additional stenting could be one of the useful options for duodenal perforation by stent. Introduction Malignant duodenal stenosis occurs in patients with advanced periampullary cancer. Insertion of a self-expanding metal stent for the treatment of this condition carries the risk of subsequent perforation of the duodenum. We report successful treatment of duodenal perforation induced by a stent. Presentation of case An 80-year-old woman suffering from stenosis caused by advanced periampullary cancer underwent metallic stent placement and her symptoms improved. While attempting biliary re-stenting to prevent restenosis after 4 months, the proximal end of the duodenal metallic stent migrated into the abdominal cavity. Using a laparotomy intraoperative endoscope, duodenal stents were placed into the prolapsed stent in the form of stent-in-stent to reduce the axial force of the stent, after which the puncture site was closed by suturing. No leakage or stenosis was observed at the duodenum, and the patient was able to eat normally until her death 4 months after surgery. Conclusion Surgical closure following intraoperative endoscopic additional stenting is a viable option for duodenal perforation caused by a stent.
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Affiliation(s)
- Kenji Shimizu
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto 861-4193, Japan
| | - Hiroshi Takamori
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto 861-4193, Japan.
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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Kim BJ, Aloia TA. Cost-effectiveness of palliative surgery versus nonsurgical procedures in gastrointestinal cancer patients. J Surg Oncol 2016; 114:316-22. [PMID: 27132654 DOI: 10.1002/jso.24280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/13/2016] [Indexed: 01/04/2023]
Abstract
Palliative care is an essential component to multidisciplinary cancer care. Improved symptom control, quality of life (QOL), and survival have resulted from its utilization. Cost-effectiveness and utility analyses are significant variables that should be considered in comparing benefits and costs of medical interventions to determine if certain treatments are economically justified. This is a review on the cost-effectiveness of palliative surgery compared to other nonsurgical palliative procedures in patients with unresectable gastrointestinal cancers. J. Surg. Oncol. 2016;114:316-322. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Bradford J Kim
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Aloia
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Sabbagh C, Dhahri A, Mariage M, Ntouba A, Yzet T, Regimbeau JM. Outcomes of duodenojejunostomy (the Grégoire procedure) for obstruction or perforation of the third and fourth portions of the duodenum. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Charles Sabbagh
- Department of Digestive, Oncological and Metabolic Surgery; Amiens University Hospital; Amiens France
| | - Abdennaceur Dhahri
- Department of Digestive, Oncological and Metabolic Surgery; Amiens University Hospital; Amiens France
| | - Maxime Mariage
- Department of Digestive, Oncological and Metabolic Surgery; Amiens University Hospital; Amiens France
| | - Alexandre Ntouba
- Department of Anaesthesiology and Critical Care Medicine; Amiens University Hospital; Amiens France
| | - Thierry Yzet
- Department of Radiology; Amiens University Hospital; Amiens France
| | - Jean-Marc Regimbeau
- Department of Digestive, Oncological and Metabolic Surgery; Amiens University Hospital; Amiens France
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Palliation of malignant gastric outlet obstruction with simultaneous endoscopic insertion of afferent and efferent jejunal limb enteral stents in patients with recurrent malignancy. Surg Endosc 2015; 30:521-525. [PMID: 26091983 DOI: 10.1007/s00464-015-4234-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/10/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with prior pancreaticobiliary or distal gastric cancer treated surgically may have local anastomotic recurrence with obstruction of the afferent and efferent jejunal limbs. This report describes the efficacy and safety of simultaneous endoscopic insertion of self-expanding metal stents into the afferent and efferent jejunal limbs in patients with gastric outlet obstruction (GOO) of post-surgical anatomy for palliation of recurrent malignancy. METHODS Patients were identified from an endoscopic database at a specialized cancer center between September 2007 and March 2014. Technical success was defined as single-session insertion of afferent and efferent jejunal limb enteral stents. Clinical success was defined as immediate symptom relief and ability to advance diet. A durable response was defined as symptom relief of at least 60 days or until hospice placement or death. RESULTS Twenty-three patients were identified who underwent insertion of two 22-mm-diameter uncovered duodenal stents. Stent length varied from 60 to 120 mm. Stents were placed under endoscopic and fluoroscopic guidance. Three patients required balloon dilation to facilitate stent insertion. Average procedure time was 58.8 min (range 28-120). Technical success was achieved in 23/24 (96%) patients. Clinical success was achieved in 19/23 (83%) patients. Following initial stent insertion and prior to subsequent re-intervention, 11/19 (58%) patients had a durable response with a median duration of 70 days (range 4-315). Eight (42%) patients underwent subsequent re-intervention at a median of 22 days (range 11-315). Five patients had stent revision and were able to tolerate oral intake. Two patients had percutaneous endoscopic gastrostomy/jejunostomy insertion. One patient required surgical diversion for persistent obstruction. Complications included stent migration and post-stent insertion bacteremia due to food bolus obstruction. CONCLUSIONS Recurrent malignant GOO in patients with post-surgical anatomy treated with simultaneous endoscopic enteral stenting of afferent and efferent jejunal limbs has a high rate of technical and clinical success and low rate of complications and provides effective palliation.
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Chok AY, Koh YX, Lee J, Wong ASY. Secondary stent-in-stent self-expanding metallic stent placement for early stent occlusion due to mucosal oedema in the gastrojejunal anastomosis after palliative subtotal gastrectomy for locally advanced gastric cancer. Singapore Med J 2015; 54:e240-3. [PMID: 24356763 DOI: 10.11622/smedj.2013249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Herein, we report a case of early in-stent occlusion due to the ingrowth of soft oedematous mucosal tissue through the lattices of an uncovered stent, which was used for palliation of a postoperative gastrojejunal anastomotic stricture. The in-stent occulsion was treated with the deployment of a second stent, which was covered, within the first stent. This led to successful resolution of the occlusion.
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Affiliation(s)
- Aik-Yong Chok
- Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Ye-Xin Koh
- Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - June Lee
- Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Andrew Siang-Yih Wong
- Herein, we report a case of early in-stent occlusion due to the ingrowth of soft oedematous mucosal tissue through the lattices of an uncovered stent, which was used for palliation of a postoperative gastrojejunal anastomotic stricture. The in-stent occulsion was treated with the deployment of a second stent, which was covered, within the first stent. This led to successful resolution of the occlusion
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Kim JW, Jeong JB, Lee KL, Kim BG, Ahn DW, Lee JK, Kim SH. Comparison between uncovered and covered self-expandable metal stent placement in malignant duodenal obstruction. World J Gastroenterol 2015; 21:1580-1587. [PMID: 25663777 PMCID: PMC4316100 DOI: 10.3748/wjg.v21.i5.1580] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/03/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the clinical outcomes of uncovered and covered self-expandable metal stent placements in patients with malignant duodenal obstruction.
METHODS: A total of 67 patients were retrospectively enrolled from January 2003 to June 2013. All patients had symptomatic obstruction characterized by nausea, vomiting, reduced oral intake, and weight loss. The exclusion criteria included asymptomatic duodenal obstruction, perforation or peritonitis, concomitant small bowel obstruction, or duodenal obstruction caused by benign strictures. The technical and clinical success rate, complication rate, and stent patency were compared according to the placement of uncovered (n = 38) or covered (n = 29) stents.
RESULTS: The technical and clinical success rates did not differ between the uncovered and covered stent groups (100% vs 96.6% and 89.5% vs 82.8%). There were no differences in the overall complication rates between the uncovered and covered stent groups (31.6% vs 41.4%). However, stent migration occurred more frequently with covered than uncovered stents [20.7% (6/29) vs 0% (0/38), P < 0.05]. Moreover, the overall cumulative median duration of stent patency was longer in uncovered than in covered stents [251 d (95%CI: 149.8 d-352.2 d) vs 139 d (95%CI: 45.5 d-232.5 d), P < 0.05 by log-rank test] The overall cumulative median survival period was not different between the uncovered stent (70 d) and covered stent groups (60 d).
CONCLUSION: Uncovered stents may be preferable in malignant duodenal obstruction because of their greater resistance to stent migration and longer stent patency than covered stents.
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Park CH, Park JC, Kim EH, Chung H, An JY, Kim HI, Shin SK, Lee SK, Cheong JH, Hyung WJ, Lee YC, Noh SH, Kim CB. Impact of carcinomatosis and ascites status on long-term outcomes of palliative treatment for patients with gastric outlet obstruction caused by unresectable gastric cancer: stent placement versus palliative gastrojejunostomy. Gastrointest Endosc 2015; 81:321-332. [PMID: 25085332 DOI: 10.1016/j.gie.2014.06.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Self-expandable metal stent (SEMS) placement and palliative gastrojejunostomy (GJJ) are palliative treatment options for malignant gastric outlet obstruction. OBJECTIVE To compare clinical outcomes of palliative treatments for gastric outlet obstruction caused by unresectable gastric cancer. DESIGN Retrospective study. SETTING University-affiliated tertiary-care hospital in the Republic of Korea. PATIENTS Two hundred fifty-six patients with gastric outlet obstruction caused by unresectable gastric cancer. INTERVENTION SEMS placement and palliative GJJ. MAIN OUTCOME MEASUREMENTS Patency duration and overall survival duration. RESULTS In total, 217 and 39 patients underwent SEMS placement and palliative GJJ, respectively, as an initial palliative treatment. Treatment modality affected reobstruction after clinical success (hazard ratio [HR] [95% confidence interval {CI}], 0.5 [0.3-0.8] of palliative GJJ). In addition, carcinomatosis with ascites was an independent associated factor of clinical success and reobstruction (HR [95% CI], 0.3 [0.1-0.7] and 1.4 [1.0-2.0], respectively). In a subgroup of patients with good performance who had neither carcinomatosis nor ascites, patency duration and overall survival duration did not differ between the 2 groups (P = .079 and P = .290, respectively). In patients with good performance who had carcinomatosis without ascites, patency duration was longer in the palliative GJJ group than in the SEMS placement group (P = .016). Overall survival, however, did not differ between the 2 groups (P = .062). In a subgroup of patients with good performance who had carcinomatosis with ascites, both patency duration and overall survival were longer in the palliative GJJ group than in the SEMS placement group (P = .007 and P = .012, respectively). LIMITATIONS Nonrandomized, retrospective study. CONCLUSION Long-term clinical outcomes of the palliative treatment modality for gastric outlet obstruction caused by unresectable gastric cancer were affected by carcinomatosis and ascites status.
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Affiliation(s)
- Chan Hyuk Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Hye Kim
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunsoo Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Kwan Shin
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Ho Cheong
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Chan Lee
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Noh
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Choong Bae Kim
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Endoscopic metallic stent insertion for malignant afferent loop obstruction using balloon-assisted enteroscopy: a case report. Am J Gastroenterol 2015; 110:355-7. [PMID: 25646922 DOI: 10.1038/ajg.2014.390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Godzhello EA, Khrustaleva MV, Sharipzhanova RD, Dekhtyar MA. [The results of endoscopic gastroduodenal, enteral and colorectal stenting for blastomatous stenosis: 8-year experience]. Khirurgiia (Mosk) 2015:51-55. [PMID: 26978764 DOI: 10.17116/hirurgia20151251-55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Gastroduodenal, enteral and colorectal stenting of blastomatous stenosis is a reasonable alternative to operative treatment of unresectable tumors. Moreover in some cases it allows to gain time and to prepare the patient for radical surgery. MATERIAL AND METHODS For the period from 2007 to 2015 in endoscopic department of acad. B.V. Petrovskiy Russian Research Center for Surgery 76 patients with piloroduodenal, enteral and colic stenoses successfully underwent self-expanding metal stents installation. There were 21 patients with malignant stenosis of the stomach and pilorobulbar area, 17 with secondary duodenal stenosis, 17 after gastrectomy and distal gastric resection; 2 with stenosing colorectal cancer, 4 patients with rectal cancer involving rectosigmoid junction, 7 with rectosigmoid junction cancer and 8 with sigmoid cancer. RESULTS Ambulatory and hospital interventions were performed in 35.5% and 64.5% of cases respectively. Hospital-stay did not exceed 2 days. The total complication rate was 11.8% (9/76), 3 of 9 patients required surgical intervention. The attention is given to important technical aspects of intervention as well as to those clinical situations when stenting is inappropriate because of absence of favourable functional outcome. CONCLUSION Stenting should be more actively implemented in clinical practice, especially in emergency surgical hospitals. However it requires adequate technical support of hospitals with different endoprostheses, because it provides simultaneous diagnostic survey and remedial procedure.
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Affiliation(s)
- E A Godzhello
- Acad. B.V. Petrovsky Russian Research Center of Surgery, Moscow
| | - M V Khrustaleva
- Acad. B.V. Petrovsky Russian Research Center of Surgery, Moscow
| | | | - M A Dekhtyar
- Acad. B.V. Petrovsky Russian Research Center of Surgery, Moscow
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Sasaki T, Isayama H, Nakai Y, Takahara N, Hamada T, Mizuno S, Mohri D, Yagioka H, Kogure H, Arizumi T, Togawa O, Matsubara S, Ito Y, Yamamoto N, Sasahira N, Hirano K, Toda N, Tada M, Koike K. Clinical outcomes of secondary gastroduodenal self-expandable metallic stent placement by stent-in-stent technique for malignant gastric outlet obstruction. Dig Endosc 2015; 27:37-43. [PMID: 24995858 DOI: 10.1111/den.12321] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/10/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM To evaluate the efficacy and safety of secondary gastroduodenal stent placement after first stent dysfunction for malignant gastric outlet obstruction. METHODS We conducted a retrospective analysis to investigate the efficacy and safety of secondary stent-in-stent gastroduodenal stent placement. RESULTS Among 260 patients who had been treated with first gastroduodenal stent placement for malignant gastric outlet obstruction, 29 patients (11.2%) were treated with secondary gastroduodenal stent placement because of first stent dysfunction. Pancreatic cancer was the major primary cancer (55.2%). A WallFlex duodenal stent was the most frequently inserted stent both as a first stent (75.9%) and as a secondary stent (62.1%). There were 22 patients (75.9%) that received gastroduodenal stents at the bending site (supraduodenal angle or infraduodenal angle). Technical and clinical success rates were 100% and 86.2%, respectively. Median eating period was 3.0 months, and median survival time was 3.5 months. As for related complications, gastrointestinal perforation, insufficient stent expansion, tumor ingrowth, tumor overgrowth, and cholangitis were experienced in 13.8% (four cases), 6.9% (two cases), 6.9% (two cases), 3.4% (one case), and 3.4% (one case), respectively. CONCLUSION Secondary gastroduodenal stent placement might be effective for managing first stent dysfunction in malignant gastric outlet obstruction. However, gastrointestinal perforation was the major complication.
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Affiliation(s)
- Takashi Sasaki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Matsumoto K, Hayashi A, Yashima K, Harada K, Takeda Y, Onoyama T, Kawata S, Ikebuchi Y, Horie Y, Murawaki Y. Late complications of self-expandable metallic stent placement for malignant gastric outlet obstruction. Intern Med 2014; 53:2773-5. [PMID: 25500437 DOI: 10.2169/internalmedicine.53.2936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was a 68-year-old man with pancreatic cancer exhibiting invasion into the superior mesenteric artery and stenosis of the third part of the duodenum. He subsequently received a duodenal stent for malignant gastric outlet obstruction. On day 43 after the placement of the duodenal stent, he reported feeling poorly, with hypotension and hematemesis. High-density areas were observed from the stomach to the rectum on computed tomography. We diagnosed the origin of bleeding as the last third of the duodenum; unfortunately, the patient died. This is the first report of massive gastrointestinal tract bleeding as a late complication of self-expandable metallic stent placement for malignant gastric outlet obstruction.
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Affiliation(s)
- Kazuya Matsumoto
- Department of Gastroenterology, Tottori University Hospital, Japan
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Enteral Stents are Safe and Effective to Relieve Malignant Gastric Outlet Obstruction in the Elderly. J Gastrointest Cancer 2014; 46:42-7. [DOI: 10.1007/s12029-014-9675-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Heo J, Jung MK. Safety and efficacy of a partially covered self-expandable metal stent in benign pyloric obstruction. World J Gastroenterol 2014; 20:16721-16725. [PMID: 25469043 PMCID: PMC4248218 DOI: 10.3748/wjg.v20.i44.16721] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/31/2014] [Accepted: 09/05/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety and efficacy of partially covered self-expandable metallic stents (SEMSs) in benign pyloric obstruction.
METHODS: We retrospectively analyzed data from 10 consecutive patients with peptic ulcer-related pyloric obstructive symptoms (gastric outlet obstruction scoring system (GOOSS) score of 1) between March 2012 and September 2013. The patients were referred to and managed by partially covered SEMS insertion in our tertiary academic center. We assessed the technical success, symptom improvement, and adverse events after stenting.
RESULTS: Early symptoms were improved just 3 d after SEMS placement in all 10 patients. The GOOSS score of all patients improved from 1 to 3. There were no serious immediate adverse events. The overall rate of being symptom free was 90% at a median of 11 mo of follow-up (range: 4-43 mo). Five patients were managed by a rescue SEMS because of failure of previous endoscopic balloon dilatation. Among them, four patients had sustained symptom improvement after the SEMS procedure. During the follow-up period, migration of the SEMS was observed in two patients (20.0%), both of whom had previous endoscopic balloon dilatation before SEMS insertion.
CONCLUSION: Despite the small number in this study, partially covered SEMSs showed a favorable and safe outcome in the treatment of naïve benign pyloric obstruction and in salvage treatment after balloon dilatation failure.
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Lye TJY, Goh YC, Eng AKH, Ong HS, Wong WK, Chan WH. Endoscopic self-expandable metallic stenting for palliation of malignant gastric outlet obstruction in Southeast Asia. ANZ J Surg 2014; 86:464-8. [PMID: 25288128 DOI: 10.1111/ans.12866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Malignant gastric outlet obstruction (GOO) is a pre-terminal event in the natural history of gastric and pancreaticobiliary cancers. The use of endoscopic placement of self-expandable metallic stents (SEMS) is a less invasive alternative palliative option for these patients. This is the first study in Southeast Asia to evaluate the clinical efficacy and safety of endoscopic SEMS placement in patients with malignant GOO. METHODS A retrospective review of our department's database in endoscopic SEMS placement for the treatment of malignant GOO was performed. Twenty-four patients with advanced or metastatic malignancy that underwent placement of SEMS for treatment of malignant GOO between January 2003 and July 2013 were analysed. The GOO severity score was used as an objective means of assessing patients' oral intake. RESULTS Technical success rate was 100%. All patients resumed oral intake of liquids within the same day of stent placement. Clinical success was achieved in 21 patients (87.5%). There was a significant improvement of GOO severity score from 0.62 ± 1.0 (mean ± standard deviation) before stent placement to 2.04 ± 0.86 after stent placement (P < 0.001). Complication rate was 12.5%. Stent-related complications observed include stent migration (two patients) and tumour ingrowth (one patient). Serious complications such as gastrointestinal haemorrhage or perforation did not occur in any patients. The median survival after stent placement was 57 days (95% confidence interval, 12.2-101.8 days). None of the patients died from stent-related complications. CONCLUSION Endoscopic SEMS placement is a minimally invasive, safe and effective option for the palliation of malignant GOO.
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Affiliation(s)
- Tiffany Jian Ying Lye
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Yaw Chong Goh
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Alvin Kim Hock Eng
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Hock Soo Ong
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Wai Keong Wong
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Weng Hoong Chan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
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Covered versus uncovered self-expandable metallic stents for palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis. BMC Gastroenterol 2014; 14:170. [PMID: 25270550 PMCID: PMC4190394 DOI: 10.1186/1471-230x-14-170] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/24/2014] [Indexed: 02/06/2023] Open
Abstract
Background Self-expandable metallic stents (SEMSs) are widely used for palliation of malignant gastric outlet obstruction (GOO). There are two types of SEMS, covered and uncovered, each with its own advantages and disadvantages. We aimed to compare the efficacy and safety between uncovered and covered SEMSs in the palliation of malignant gastric outlet obstruction. Methods Databases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index and momentous meeting abstracts were searched and evaluated by two reviewers independently. Results Nine trials involving 849 patients were analyzed. Meta-analysis showed there was no significant difference in technical success rate (RR 1.0, 95% CI [0.98, 1.01]), clinical success rate (RR 1.04, 95% CI [0.98, 1.11]), post-stenting dysphagia score (WMD −0.01, 95% CI [−0.52, 0.50]), stent patency (WMD −0.31, 95% CI [−1.73, 1.11]), overall complications (RR 1.07, 95% CI [0.87, 1.32]) and reintervention rate (RR 1.30, 95% CI [0.92, 1.83]) between covered and uncovered SEMSs group. However, covered SEMSs were associated with higher migration rate (RR 3.48, 95% CI [2.16, 5.62], P < 0.00001) and lower obstruction rate (RR 0.42, 95% CI [0.24, 0.73], P = 0.002). Conclusions In the palliative treatment of malignant gastric outlet obstruction, both covered and uncovered SEMSs are safely and effective. Covered stents can reduce the risk of restenosis, whereas uncovered stents are effective in decreasing stent migration.
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48
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Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction. CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-014-0048-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Singh A, Ross WA, Bhattacharya A, Xiao L, Dekovich AA, Davila M, Raju GS, Lee JE, Fleming JB, Lee JH. Gastrojejunostomy versus enteral self-expanding metal stent placement in patients with a malignant gastric outlet obstruction. GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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50
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Gastroduodenal outlet obstruction and palliative self-expandable metal stenting: a dual-centre experience. JOURNAL OF ONCOLOGY 2013; 2013:167851. [PMID: 24319458 PMCID: PMC3844165 DOI: 10.1155/2013/167851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/24/2013] [Accepted: 09/26/2013] [Indexed: 11/20/2022]
Abstract
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 28–93 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 0–49) without any significant differences between types of primary malignancy. Mean hospital stay was 3 days (range 1–20). 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.
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