Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Chandrasegaram MD, Eslick GD, Mansfield CO, Liem H, Richardson M, Ahmed S, Cox MR. Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction. Surg Endosc 2012;26:323-329. [PMID: 21898024 DOI: 10.1007/s00464-011-1870-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 08/01/2011] [Indexed: 02/12/2023]

For:	Chandrasegaram MD, Eslick GD, Mansfield CO, Liem H, Richardson M, Ahmed S, Cox MR. Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction. Surg Endosc 2012;26:323-329. [PMID: 21898024 DOI: 10.1007/s00464-011-1870-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 08/01/2011] [Indexed: 02/12/2023]

Number

Cited by Other Article(s)

Yamashige D, Hijioka S, Nagashio Y, Maruki Y, Fukuda S, Yagi S, Okamoto K, Hara H, Hagiwara Y, Agarie D, Takasaki T, Chatto M, Ohba A, Kondo S, Morizane C, Ueno H, Sone M, Saito Y, Okusaka T. Incidence and factors associated with stent dysfunction and pancreatitis after gastroduodenal stenting for malignant gastric outlet obstruction. Endosc Int Open 2024;12:E367-E376. [PMID: 38464977 PMCID: PMC10919994 DOI: 10.1055/a-2261-2833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/13/2023] [Indexed: 03/12/2024] Open

Affiliation(s)

Daiki Yamashige Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Susumu Hijioka Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Yoshikuni Nagashio Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Yuta Maruki Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Soma Fukuda Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Shin Yagi Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Kohei Okamoto Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Hidenobu Hara Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Yuya Hagiwara Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Daiki Agarie Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Tetsuro Takasaki Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Mark Chatto Department of Gastroenterology, Makati Medical Center, Makati City, Philippines
Akihiro Ohba Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Shunsuke Kondo Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Chigusa Morizane Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Hideki Ueno Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan
Miyuki Sone Department of Diagnostic Radiology, National Cancer Center Japan, Chuo-ku, Japan
Yutaka Saito Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
Takuji Okusaka Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan

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Takahara N, Nakai Y, Ishida K, Endo G, Kurihara K, Tange S, Takaoka S, Tokito Y, Suzuki Y, Oyama H, Kanai S, Suzuki T, Sato T, Hakuta R, Ishigaki K, Saito T, Hamada T, Fujishiro M. Second Covered and Uncovered Self-Expandable Metal Stents for Recurrent Gastric Outlet Obstruction: A Retrospective Comparative Study. J Clin Med 2023;12:5241. [PMID: 37629282 PMCID: PMC10455318 DOI: 10.3390/jcm12165241] [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: 04/22/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open

Abstract

Background: Endoscopic self-expandable metal stent (SEMS) placement is a current mainstay for malignant gastric outlet obstruction (GOO), but symptomatic recurrence due to initial SEMS dysfunction commonly occurs. We aimed to compare the safety and effectiveness of second SEMS for recurrent GOO (RGOO). Methods: Between April 2006 and December 2022, a total of 95 cases with malignant RGOO undergoing second endoscopic SEMS placement were enrolled. Technical and clinical success rates, RGOO, time to RGOO (TRGOO), stent patency rate, adverse events (AE), and overall survival (OS) were retrospectively compared between covered and uncovered SEMS (cSEMS/uSEMS) groups. Risk factors for TRGOO were also explored. Results: Baseline characteristics were well balanced between cSEMS (n = 48) and uSEMS (n = 47) groups, except for the causes of the initial SEMS dysfunction. High technical and clinical success rates with a similar incidence of AE (15% vs. 17%, p = 0.78) and OS (median of 101 vs. 102 days, p = 0.68) were achieved in both groups. There were no statistical differences in cumulative incidence of RGOO (19% vs. 13%, p = 0.58), TRGOO (median, not reached in both groups, p = 0.57), and stent patency rates at 1, 2, and 3 months between the groups (60%, 47% and 26%, respectively vs. 70%, 55% and 38%, respectively). However, TRGOO tended to be longer in cSEMS in cases with RGOO due to tumor ingrowth (median, not reached vs. 111 days, p = 0.19). A Cox regression analysis demonstrated that chemotherapy after second SEMS placement was significantly associated with an improved TRGOO (the hazard ratio of 0.27 [95% confidence interval, 0.08-0.93], p = 0.03). Conclusions: Regardless of the type of SEMS, second SEMS placement was similarly safe and effective for RGOO. The type of second SEMS might be considered based on the cause of initial SEMS dysfunction.

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Affiliation(s)

Naminatsu Takahara Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Yousuke Nakai Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.) Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Kota Ishida Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Go Endo Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Kohei Kurihara Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Shuichi Tange Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Shinya Takaoka Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Yurie Tokito Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Yukari Suzuki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Hiroki Oyama Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Sachiko Kanai Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.) Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Tatsunori Suzuki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Tatsuya Sato Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Ryunosuke Hakuta Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Kazunaga Ishigaki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.) Department of Chemotherapy, The University of Tokyo Hospital, Tokyo 113-8655, Japan
Tomotaka Saito Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)
Tsuyoshi Hamada Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.) Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
Mitsuhiro Fujishiro Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (N.T.); (K.I.); (G.E.); (K.K.); (S.T.); (S.T.); (Y.T.); (Y.S.); (H.O.); (S.K.); (T.S.); (T.S.); (R.H.); (K.I.); (T.S.); (T.H.); (M.F.)

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Cohen JT, Beard RE, Cioffi WG, Miner TJ. Was It Worth It? Critical Evaluation of a Novel Outcomes Measure in Oncologic Palliative Surgery. J Am Coll Surg 2023;236:1156-1162. [PMID: 36786475 DOI: 10.1097/xcs.0000000000000649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]

Abstract

BACKGROUND

Patient selection for palliative surgery is complex, and appropriate outcomes measures are incompletely defined. We explored the usefulness of a specific outcomes measure "was it worth it" in patients after palliative-intent operations for advanced malignancy.

STUDY DESIGN

A retrospective review of a comprehensive longitudinal palliative surgery database was performed at an academic tertiary care center. All patients who underwent palliative-intent operation for advanced cancer from 2003 to 2022 were included. Patient satisfaction ("was it worth it") was reported within 30 days of operation after palliative-intent surgery.

RESULTS

A total of 180 patients were identified, and 81.7% self-reported that their palliative surgery was "worth it." Patients who reported that their surgery was "not worth it" were significantly older and were more likely to have recurrent symptoms and to need reoperation. There was no significant difference in overall, recurrence-free, and reoperation-free survival for patients when comparing "worth it" with "not worth it." Initial symptom improvement was not significantly different between groups. Age older than 65 years (hazard ratio 0.25, 95% CI 0.07 to 0.80, p = 0.03), family engagement (hazard ratio 6.71, 95% CI 1.49 to 31.8, p = 0.01), and need for reoperation (hazard ratio 0.042, 95% CI 0.01 to 0.16, p < 0.0001) were all independently associated with patients reporting that their operation was "worth it."

CONCLUSIONS

Here we demonstrate that simply asking a patient "was it worth it" after a palliative-intent operation identifies a distinct cohort of patients that traditional outcomes measures fail to distinguish. Family engagement and durability of an intervention are critical factors in determining patient satisfaction after palliative intervention. These data highlight the need for highly individualized care with special attention paid to patients self-reporting that their operation was "not worth it."

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Rebhun J, Shin CM, Siddiqui UD, Villa E. Endoscopic biliary treatment of unresectable cholangiocarcinoma: A meta-analysis of survival outcomes and systematic review. World J Gastrointest Endosc 2023;15:177-190. [PMID: 37034966 PMCID: PMC10080560 DOI: 10.4253/wjge.v15.i3.177] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/12/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open

Abstract

BACKGROUND

Endoscopic radiofrequency ablation (ERFA), percutaneous radiofrequency ablation (PRFA), and photodynamic therapy (PDT), when used in conjunction with conventional biliary stenting, have demonstrated a survival benefit in patients with unresectable cholangiocarcinoma.

AIM

To compare pooled survival outcomes, adverse event rates, and mean stent patency for those undergoing these procedures.

METHODS

A comprehensive literature review of published studies and abstracts from January 2011 to December 2020 was performed comparing survival outcomes in patients undergoing ERFA with stenting, biliary stenting alone, PRFA with stenting, and PDT with stenting for unresectable cholangiocarcinoma (CCA).

RESULTS

Data from four studies demonstrated a pooled mean survival favoring ERFA as compared to biliary stenting alone (12.0 ± 0.9 mo vs 6.8 ± 0.3 mo, P < 0.001) as well as statistically improved median survival time (13 mo vs 8 mo, P < 0.001). Both ERFA with stenting and PRFA with stenting groups demonstrated statistical superiority to biliary stenting alone (P < 0.001 and P = 0.004, respectively). However, when comparing ERFA to PRFA, pooled data demonstrated overall higher mean survival in the ERFA with stenting cohort as compared to PRFA with stent cohort (12.0 + 0.9 mo vs 8.1 + 2.1 mo, P < 0.0001). Data from two studies demonstrated a pooled median survival favoring ERFA with stenting as compared to PDT with stenting (11.3 mo vs 8.5 mo, P = 0.02).

CONCLUSION

While further prospective, randomized studies are needed to assess efficacy of ERFA, our meta-analysis demonstrated that this technique offers endoscopists a reasonable palliative method by which to treat patients with unresectable CCA that results in longer survival as compared to biliary stenting alone, percutaneous radiofrequency ablation with biliary stenting, and PDT with biliary stenting as well as an acceptable adverse event profile based on available published data.

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Del Nero L, Sheijani AD, De Ceglie A, Bruzzone M, Ceppi M, Filiberti RA, Siersema P, Conio M. A Meta-Analysis of Endoscopic Stenting Versus Surgical Treatment for Malignant Gastric Outlet Obstruction. World J Surg 2023;47:1519-1529. [PMID: 36869171 DOI: 10.1007/s00268-023-06944-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 03/05/2023]

Jaruvongvanich V, Mahmoud T, Abu Dayyeh BK, Chandrasekhara V, Law R, Storm AC, Levy MJ, Vargas EJ, Marya NB, Abboud DM, Ghazi R, Matar R, Rapaka B, Buttar N, Truty MJ, Aerts M, Messaoudi N, Kunda R. Endoscopic ultrasound-guided gastroenterostomy for the management of gastric outlet obstruction: A large comparative study with long-term follow-up. Endosc Int Open 2023;11:E60-E66. [PMID: 36644538 PMCID: PMC9839427 DOI: 10.1055/a-1976-2279] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open

Affiliation(s)

Veeravich Jaruvongvanich Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Tala Mahmoud Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Barham K. Abu Dayyeh Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Vinay Chandrasekhara Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Ryan Law Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Andrew C. Storm Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Michael J. Levy Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Eric J. Vargas Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Neil B. Marya Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts, United States
Donna M. Abboud Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Rabih Ghazi Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Reem Matar Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Babusai Rapaka Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Navtej Buttar Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Mark J. Truty Division of Surgery, Mayo Clinic, Rochester, Minnesota, United States
Maridi Aerts Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
Nouredin Messaoudi Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
Rastislav Kunda Department of Surgery, Department of Gastroenterology-Hepatology, Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium

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Inokuma A, Takahara N, Ishibashi R, Hakuta R, Ishigaki K, Saito K, Saito T, Hamada T, Mizuno S, Yagioka H, Takahashi S, Kogure H, Sasaki T, Hirano K, Ito Y, Isayama H, Nakai Y, Koike K, Fujishiro M. Comparison of novel large-bore and conventional-bore covered self-expandable metal stents for malignant gastric outlet obstruction: Multicenter, retrospective study. Dig Endosc 2023;35:111-121. [PMID: 35916499 DOI: 10.1111/den.14418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/31/2022] [Indexed: 01/17/2023]

Affiliation(s)

Akiyuki Inokuma Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Naminatsu Takahara Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Rei Ishibashi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Ryunosuke Hakuta Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Kazunaga Ishigaki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Kei Saito Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tomotaka Saito Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tsuyoshi Hamada Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Suguru Mizuno Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Hiroshi Yagioka Department of Gastroenterology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
Sho Takahashi Department of Gastroenterology, Juntendo University, Tokyo, Japan
Hirofumi Kogure Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Takashi Sasaki Department of Hepato-Biliary Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Kenji Hirano Department of Gastroenterology, Tokyo Takanawa Hospital of Japan Community Health-care Organization, Tokyo, Japan
Yukiko Ito Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan
Hiroyuki Isayama Department of Gastroenterology, Juntendo University, Tokyo, Japan
Yousuke Nakai Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Kazuhiko Koike Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Mitsuhiro Fujishiro Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

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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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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]

Kaneko J, Ishiwatari H, Asakura K, Satoh T, Sato J, Ishikawa K, Matsubayashi H, Yabuuchi Y, Kishida Y, Yoshida M, Ito S, Kawata N, Imai K, Takizawa K, Hotta K, Ono H. Biliary obstruction and pancreatitis after duodenal stent placement in the descending duodenum: a retrospective study. BMC Gastroenterol 2022;22:257. [PMID: 35597896 PMCID: PMC9123653 DOI: 10.1186/s12876-022-02333-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/13/2022] [Indexed: 12/07/2022] Open

Affiliation(s)

Junichi Kaneko Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Hirotoshi Ishiwatari Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Koiku Asakura Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
Tatsunori Satoh Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Junya Sato Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Kazuma Ishikawa Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Hiroyuki Matsubayashi Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan
Yohei Yabuuchi Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Yoshihiro Kishida Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Masao Yoshida Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Sayo Ito Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Noboru Kawata Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Kenichiro Imai Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Kohei Takizawa Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Kinichi Hotta Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
Hiroyuki Ono Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

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Vreeland TJ, Bohan PMK, Newhook TE, Allen CJ, Prakash LR, Maxwell JE, Ikoma N, Kim MP, Lee JE, Katz MHG, Tzeng CWD. Contemporary Assessment of Need for Palliative Bypass After Aborted Pancreatoduodenectomy Following Neoadjuvant Therapy. J Gastrointest Surg 2022;26:352-359. [PMID: 35064457 DOI: 10.1007/s11605-021-05224-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 11/13/2021] [Indexed: 01/31/2023]

Abstract

BACKGROUND

Planned pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) can be aborted due to intraoperative findings. There is little guidance regarding the need for prophylactic bypass following an aborted PD to prevent symptomatic biliary obstruction or gastric outlet obstruction (GOO) postoperatively. The aim of this study was to characterize postoperative interventions and postsurgical survival in patients following aborted PD.

METHODS

Patients with PDAC treated with neoadjuvant therapy and staging laparoscopy prior to planned PD between 2010 and 2015 were reviewed for aborted PDs. Data on postoperative biliary obstruction, GOO, procedural intervention, and postsurgical survival were analyzed.

RESULTS

Of 271 planned PDs, 47 (17.3%) were aborted. Thirty-six patients had ≥ 2 months of follow-up data and were included. Six patients underwent hepaticojejunostomy and nine patients underwent gastrojejunostomy at the time of the aborted PD. Sixteen of 30 patients (53%) without a surgical biliary bypass required endoscopic intervention, but none required palliative surgery. Ten of 27 patients (37%) without an operative gastrojejunostomy required intervention, but none required palliative surgery. Endoscopic or percutaneous therapy was required to treat 13/16 (81%) patients who presented with postoperative biliary obstructions and 6/10 (60%) of GOOs. Median survival following aborted PD was 13.3 months (CI 8.9-17.7). There were no differences in survival when comparing patients who developed a biliary obstruction (p = 0.92) or GOO (p = 0.90) to asymptomatic patients.

CONCLUSIONS

Following aborted PD, patients commonly develop obstructive symptoms. However, these symptoms can generally be managed without surgical intervention. In asymptomatic patients, preemptive surgical bypasses are not required at the time of aborted PD.

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Yamao K, Kitano M, Chiba Y, Ogura T, Eguchi T, Moriyama I, Yamashita Y, Kato H, Kayahara T, Hoki N, Okabe Y, Shiomi H, Nakai Y, Kushiyama Y, Fujimoto Y, Hayashi S, Bamba S, Kudo Y, Azemoto N, Ueki T, Uza N, Asada M, Matsumoto K, Nebiki H, Takihara H, Noguchi C, Kamada H, Nakase K, Goto D, Sanuki T, Koga T, Hashimoto S, Nishikiori H, Serikawa M, Hanada K, Hirao K, Ohana M, Kazuyuki I, Kato T, Yoshida M, Kawamoto H. Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction. Gut 2021;70:1244-1252. [PMID: 33223499 PMCID: PMC8223634 DOI: 10.1136/gutjnl-2020-320775] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022]

Affiliation(s)

Kentaro Yamao Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osakasayama, Osaka, Japan
Masayuki Kitano Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osakasayama, Osaka, Japan .,Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
Yasutaka Chiba Clinical Research Center, Kindai University Hospital, Osaka-sayama, Japan
Takeshi Ogura Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
Takaaki Eguchi Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
Ichiro Moriyama Innovative Cancer Center, Shimane University Hospital, Matsue, Shimane, Japan
Yukitaka Yamashita Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
Hironari Kato Department of Gastroenterology and Hepatology, Okayama University, Okayama, Japan
Takahisa Kayahara Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan
Noriyuki Hoki Gastroenterology, Bell Land General Hospital, Sakai, Japan
Yoshinobu Okabe Division of Gastroenterology, Department of Medicine, Kurume University, Kurume, Japan
Hideyuki Shiomi Division of Gastroenterology, Department of Internal Medicine, Kobe University, Kobe, Hyogo, Japan
Yoshitaka Nakai Digestive Disease Center, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan
Yoshinori Kushiyama Department of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
Yoshifumi Fujimoto Department of Gastroenterology and Hepatology, JA Hiroshima Koseiren Hiroshima General Hospital, Hatsukaichi, Hiroshima, Japan
Shiro Hayashi Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
Shigeki Bamba Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan
Yasushi Kudo Digestive Disease Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
Nobuaki Azemoto Department of Gastroenterology, Shikoku Cancer Center, Matuyama, Japan
Toshiharu Ueki Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan
Norimitsu Uza Department of Gastroenterology and Hepatology, Kyoto University, Kyoto, Japan
Masanori Asada Department of Gastroenterology and Hepatology, Japanese Red Cross Society Osaka Hospital, Osaka, Osaka, Japan
Kazuya Matsumoto Division of Medicine and Clinical Science, Tottori University, Yonago, Japan
Hiroko Nebiki Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
Hiroshi Takihara Department of Gastroenterology and Hepatology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
Chisio Noguchi Department of Gastroenterology, Shinbeppu Hospital, Beppu, Japan
Hideki Kamada Gastroenterology and Neurology, Kagawa University, Kagawa, Japan
Kojiro Nakase Department of Gastroenterology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
Daisuke Goto Department of Gastroenterology and Hepatology, Tottori Municipal Hospital, Tottori, Japan,Department of Gastroenterology and Hepatology, Tottori Red Cross Hospital, Tottori, Japan
Tsuyoshi Sanuki Department of Gastroenterology, Kitaharima Medical Center, Ono, Japan
Tetsuya Koga Department of Gastroenterology, Social Media Corporation Tenyoukai Central Hospital, Kagoshima, Japan
Shinichi Hashimoto Digestive and Life-style Diseases, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Kagoshima, Japan
Hidefumi Nishikiori Department of Gastroenterology, Oita Sanai Medical Center, Oita, Japan
Masahiro Serikawa Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
Keiji Hanada Department of Gastroenterology, Onomichi General Hospital, Onomichi, Hiroshima, Japan
Ken Hirao Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
Masaya Ohana Department of Gastroenterology, Tenri Hospital, Tenri, Nara, Japan
Imakiire Kazuyuki Department of Gastroenterology, Imakiire General Hospital, Kagoshima, Japan
Takao Kato Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
Motoyuki Yoshida Third department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
Hirofumi Kawamoto General Medicine 2, Kawasaki Medical School, Okayama, Japan

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Klose J, Rieder S, Ronellenfitsch U. Surgical and interventional treatment options in unresectable gastrointestinal cancer. SURGERY IN PRACTICE AND SCIENCE 2021. [DOI: 10.1016/j.sipas.2021.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open

Cheung SLH, Teoh AYB. Optimal Management of Gastric Outlet Obstruction in Unresectable Malignancies. Gut Liver 2021;16:190-197. [PMID: 34039779 PMCID: PMC8924806 DOI: 10.5009/gnl210010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022] Open

Klose J, Ronellenfitsch U, Kleeff J. Management problems in patients with pancreatic cancer from a surgeon's perspective. Semin Oncol 2021;48:76-83. [PMID: 34059343 DOI: 10.1053/j.seminoncol.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 12/25/2022]

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]

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
Christopher J DiMaio Department of Gastroenterology, Mount Sinai, New York, New York, 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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Patita M, Castro R, Libânio D, Bastos RP, Silva R, Dinis-Ribeiro M, Pimentel-Nunes P. Covered Metal Stent after Dysfunction of Uncovered Stents for Palliation of Gastrointestinal Malignant Obstruction. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020;27:383-390. [PMID: 33251287 PMCID: PMC7670366 DOI: 10.1159/000507200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022]

Cohen JT, Fallon EA, Charpentier KP, Cioffi WG, Miner TJ. Improving the value of palliative surgery by optimizing patient selection: The role of long-term survival on high impact palliative intent operations. Am J Surg 2020;221:1018-1023. [PMID: 32980077 DOI: 10.1016/j.amjsurg.2020.08.034] [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: 06/19/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]

Palliative care for advanced gastric cancer. Expert Rev Anticancer Ther 2020;20:575-580. [PMID: 32543938 DOI: 10.1080/14737140.2020.1781620] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]

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

Fisher AV, Hanlon B, Fernandes-Taylor S, Schumacher JR, Lawson EH, Ronnekleiv-Kelly SM, Minter RM, Weber SM, Abbott DE. Natural history and cost analysis of surgical bypass versus endoscopic stenting for the palliative management of malignant gastric outlet obstruction. HPB (Oxford) 2020;22:529-536. [PMID: 31519358 DOI: 10.1016/j.hpb.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]

Affiliation(s)

Alexander V Fisher University of Wisconsin Institute for Surgical Outcomes Research (WiSOR), 600 Highland Avenue, Madison, WI 53792, United States; University of Wisconsin, Department of Surgery, Division of Surgical Oncology, H4/710 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, United States
Bret Hanlon University of Wisconsin Institute for Surgical Outcomes Research (WiSOR), 600 Highland Avenue, Madison, WI 53792, United States
Sara Fernandes-Taylor University of Wisconsin Institute for Surgical Outcomes Research (WiSOR), 600 Highland Avenue, Madison, WI 53792, United States
Jessica R Schumacher University of Wisconsin Institute for Surgical Outcomes Research (WiSOR), 600 Highland Avenue, Madison, WI 53792, United States
Elise H Lawson University of Wisconsin Institute for Surgical Outcomes Research (WiSOR), 600 Highland Avenue, Madison, WI 53792, United States
Sean M Ronnekleiv-Kelly University of Wisconsin Institute for Surgical Outcomes Research (WiSOR), 600 Highland Avenue, Madison, WI 53792, United States; University of Wisconsin, Department of Surgery, Division of Surgical Oncology, H4/710 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, United States
Rebecca M Minter University of Wisconsin Institute for Surgical Outcomes Research (WiSOR), 600 Highland Avenue, Madison, WI 53792, United States; University of Wisconsin, Department of Surgery, Division of Surgical Oncology, H4/710 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, United States
Sharon M Weber University of Wisconsin Institute for Surgical Outcomes Research (WiSOR), 600 Highland Avenue, Madison, WI 53792, United States; University of Wisconsin, Department of Surgery, Division of Surgical Oncology, H4/710 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, United States
Daniel E Abbott University of Wisconsin Institute for Surgical Outcomes Research (WiSOR), 600 Highland Avenue, Madison, WI 53792, United States; University of Wisconsin, Department of Surgery, Division of Surgical Oncology, H4/710 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, United States.

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Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer. Gastroenterol Res Pract 2019;2019:8093091. [PMID: 31354809 PMCID: PMC6636570 DOI: 10.1155/2019/8093091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/12/2019] [Accepted: 04/30/2019] [Indexed: 11/17/2022] Open

Mintziras I, Miligkos M, Wächter S, Manoharan J, Bartsch DK. Palliative surgical bypass is superior to palliative endoscopic stenting in patients with malignant gastric outlet obstruction: systematic review and meta-analysis. Surg Endosc 2019;33:3153-3164. [PMID: 31332564 DOI: 10.1007/s00464-019-06955-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/01/2019] [Indexed: 12/11/2022]

Cohen JT, Miner TJ. Patient selection in palliative surgery: Defining value. J Surg Oncol 2019;120:35-44. [DOI: 10.1002/jso.25512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/25/2019] [Accepted: 04/22/2019] [Indexed: 12/27/2022]

Shi D, Liu J, Hu X, Liu Y, Ji F, Bao Y, Guo D. Comparison of big funnel and individualized stents for management of stomach cancer with gastric outlet obstruction. Medicine (Baltimore) 2018;97:e13194. [PMID: 30508898 PMCID: PMC6283228 DOI: 10.1097/md.0000000000013194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open

Brunner M, Grützmann R, Weber GF. [Palliative therapy concepts for pancreatic carcinoma]. Chirurg 2018;89:737-750. [PMID: 30094706 DOI: 10.1007/s00104-018-0696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Pais-Cunha I, Castro R, Libânio D, Pita I, Bastos RP, Silva R, Dinis-Ribeiro M, Pimentel-Nunes P. Endoscopic stenting for palliation of intra-abdominal gastrointestinal malignant obstruction: predictive factors for clinical success. Eur J Gastroenterol Hepatol 2018;30:1033-1040. [PMID: 29851864 DOI: 10.1097/meg.0000000000001178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Abstract

BACKGROUND

Endoscopic stenting proved to be a safe alternative to surgery for malignant intra-abdominal gastrointestinal obstruction. Although high technical success rates have been reported, some patients do not experience relief in symptoms.

AIM

This study aimed to analyse the factors predicting the effectiveness of stent placement in patients with gastrointestinal obstruction.

PATIENTS AND METHODS

A retrospective study was carried out including 160 patients who underwent palliative stenting for intra-abdominal obstruction in a tertiary centre from December 2012 to July 2017. Technical and clinical success, stent dysfunction and adverse events were analysed.

RESULTS

The rate of technical success was 98%. The rate of early clinical success was 69 and 81% in upper and lower gastrointestinal obstructions, respectively (P=0.107). In the upper tract, obstruction caused by carcinomatosis was the only independent factor predicting early and late clinical failure [odds ratio (OR): 9.7, 95% confidence interval (CI): 2.5-38.4, P=0.001 and OR: 7.6, 95% CI: 1.8-31.9, P=0.006, respectively]. In the colon, Eastern Cooperative Oncology Group score of at least 3 was an independent factor for early clinical failure (OR: 29.8, 95% CI: 1.9-464.9, P=0.002) and obstruction caused by carcinomatosis was an independent factor for late clinical failure (OR: 14.4, 95% CI: 1.7-119.6, P=0.013). Perforation occurred in 4 patients (2.5%) and stent dysfunction occurred in 15% of patients (4% stent migration; 9% restenosis). Carcinomatosis was a risk factor for perforation (P=0.039) and migration was higher with shorter 6 cm stents (P=0.044).

CONCLUSION

Stents are effective and safe for palliation of intra-abdominal obstruction. Carcinomatosis predicts an unfavourable clinical outcome. Palliative stenting as an option should be weighed carefully in these patients.

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Yamao K, Kitano M, Takenaka M, Minaga K, Sakurai T, Watanabe T, Kayahara T, Yoshikawa T, Yamashita Y, Asada M, Okabe Y, Hanada K, Chiba Y, Kudo M. Outcomes of endoscopic biliary drainage in pancreatic cancer patients with an indwelling gastroduodenal stent: a multicenter cohort study in West Japan. Gastrointest Endosc 2018;88:66-75.e2. [PMID: 29382465 DOI: 10.1016/j.gie.2018.01.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/18/2018] [Indexed: 12/11/2022]

Uemura S, Iwashita T, Iwata K, Mukai T, Osada S, Sekino T, Adachi T, Kawai M, Yasuda I, Shimizu M. Endoscopic duodenal stent versus surgical gastrojejunostomy for gastric outlet obstruction in patients with advanced pancreatic cancer. Pancreatology 2018;18:601-607. [PMID: 29753623 DOI: 10.1016/j.pan.2018.04.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 12/11/2022]

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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Manuel-Vázquez A, Latorre-Fragua R, Ramiro-Pérez C, López-Marcano A, De la Plaza-Llamas R, Ramia JM. Laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature. World J Gastroenterol 2018;24:1978-1988. [PMID: 29760541 PMCID: PMC5949711 DOI: 10.3748/wjg.v24.i18.1978] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/26/2018] [Accepted: 05/06/2018] [Indexed: 02/06/2023] Open

Laparoscopic Gastrojejunostomy for Patients with Unresectable Gastric Cancer with Gastric Outlet Obstruction. J Gastrointest Surg 2017;21:1220-1225. [PMID: 28224464 DOI: 10.1007/s11605-017-3387-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/13/2017] [Indexed: 01/31/2023]

Takahara N, Isayama H, Nakai Y, Yoshida S, Saito T, Mizuno S, Yagioka H, Kogure H, Togawa O, Matsubara S, Ito Y, Yamamoto N, Tada M, Koike K. A Novel Partially Covered Self-Expandable Metallic Stent with Proximal Flare in Patients with Malignant Gastric Outlet Obstruction. Gut Liver 2017;11:481-488. [PMID: 28208004 PMCID: PMC5491082 DOI: 10.5009/gnl16259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/14/2016] [Accepted: 09/27/2016] [Indexed: 12/15/2022] Open

Jang SH, Lee H, Min BH, Kim SM, Kim HS, Carriere KC, Min YW, Lee JH, Kim JJ. Palliative gastrojejunostomy versus endoscopic stent placement for gastric outlet obstruction in patients with unresectable gastric cancer: a propensity score-matched analysis. Surg Endosc 2017;31:4217-4223. [PMID: 28281127 DOI: 10.1007/s00464-017-5480-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 02/16/2017] [Indexed: 12/16/2022]

Bian SB, Shen WS, Xi HQ, Wei B, Chen L. Palliative Therapy for Gastric Outlet Obstruction Caused by Unresectable Gastric Cancer: A Meta-analysis Comparison of Gastrojejunostomy with Endoscopic Stenting. Chin Med J (Engl) 2017;129:1113-21. [PMID: 27098799 PMCID: PMC4852681 DOI: 10.4103/0366-6999.180530] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open

Abstract

Background:

Gastrojejunostomy (GJJ) and endoscopic stenting (ES) are palliative treatments for gastric outlet obstruction (GOO) caused by gastric cancer. We compared the outcomes of GJJ with ES by performing a meta-analysis.

Methods:

Clinical trials that compared GJJ with ES for the treatment of GOO in gastric cancer were included in the meta-analysis. Procedure time, time to resumption of oral intake, duration of hospital stay, patency duration, and overall survival days were compared using weighted mean differences (WMDs). Technical success, clinical success, procedure-related mortality, complications, the rate of re-obstruction, postoperative chemotherapy, and reintervention were compared using odds ratios (ORs).

Results:

Nine studies were included in the analysis. Technical success and clinical success were not significantly different between the ES and GJJ groups. The ES group had a shorter procedure time (WMD = −80.89 min, 95% confidence interval [CI] = −93.99 to −67.78, P < 0.001), faster resumption of oral intake (WMD = −3.45 days, 95% CI = –5.25 to −1.65, P < 0.001), and shorter duration of hospital stay (WMD = −7.67 days, 95% CI = −11.02 to −4.33, P < 0.001). The rate of minor complications was significantly higher in the GJJ group (OR = 0.13, 95% CI = 0.04–0.40, P < 0.001). However, the rates of major complications (OR = 6.91, 95% CI = 3.90–12.25, P < 0.001), re-obstruction (OR= 7.75, 95% CI = 4.06–14.78, P < 0.001), and reintervention (OR= 6.27, 95% CI = 3.36–11.68, P < 0.001) were significantly lower in the GJJ group than that in the ES group. Moreover, GJJ was significantly associated with a longer patency duration (WMD = −167.16 days, 95% CI = −254.01 to −89.31, P < 0.001) and overall survival (WMD = −103.20 days, 95% CI = −161.49 to −44.91, P = 0.001).

Conclusions:

Both GJJ and ES are effective procedures for the treatment of GOO caused by gastric cancer. ES is associated with better short-term outcomes. GJJ is preferable to ES in terms of its lower rate of stent-related complications, re-obstruction, and reintervention. GJJ should be considered a treatment option for patients with a long life expectancy and good performance status.

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Perone JA, Riall TS, Olino K. Palliative Care for Pancreatic and Periampullary Cancer. Surg Clin North Am 2017;96:1415-1430. [PMID: 27865285 DOI: 10.1016/j.suc.2016.07.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

Badgwell B. Palliative surgery. J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Yamao K, Kitano M, Kayahara T, Ishida E, Yamamoto H, Minaga K, Yamashita Y, Nakajima J, Asada M, Okabe Y, Osaki Y, Chiba Y, Imai H, Kudo M. Factors predicting through-the-scope gastroduodenal stenting outcomes in patients with gastric outlet obstruction: a large multicenter retrospective study in West Japan. Gastrointest Endosc 2016;84:757-763.e6. [PMID: 27055762 DOI: 10.1016/j.gie.2016.03.1498] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/26/2016] [Indexed: 02/07/2023]

Abstract

BACKGROUND AND AIMS

Endoscopic gastroduodenal stenting for malignant gastric outlet obstruction recently has become more effective, but the factors that predict gastroduodenal stenting outcomes are poorly defined. This multicenter retrospective cohort study evaluated the clinical outcomes of gastroduodenal stenting in malignant gastroduodenal obstruction and identified factors predicting clinical ineffectiveness, stent dysfunction, and adverse events.

METHODS

All consecutive patients with malignant gastroduodenal obstruction who underwent through-the-scope gastroduodenal stenting from 2009 to 2014 at 4 tertiary-care medical centers were identified. Clinically ineffective stenting was defined as symptom recurrence and a gastric outlet obstruction scoring system (GOOSS) score <2.

RESULTS

Of the 278 patients (mean age ± standard deviation [SD] 71.7 ± 11.4 years), 121 (43.5%) and 87 (31.3%) had pancreatic and gastric cancer, respectively. Technical success was achieved in 277 patients (99.6%). GOOSS scores rose from 0.5 ± 0.6 to 2.6 ± 0.8. Stenting was ineffective in 32 patients (12.6%). Stent dysfunction that caused symptom recurrence during follow-up developed in 46 patients (16.6%). Adverse events occurred in 49 patients (17.7%). Three or more stenosis sites (odds ratio [OR] = 6.11; P < .01) and Karnofsky performance scores ≤50 (OR = 6.63; P < .01) predicted clinical ineffectiveness. Karnofsky performance scores ≤50 predicted stent dysfunction (hazard ratio [HR] = 3.63; P < .01). Bile duct stenosis (HR = 9.55; P = .02) and liver metastasis (HR = 9.42; P < .01) predicted stent overgrowth. Covered stent predicted stent migration (HR = 12.63; P < .01). Deployment of 2 stents predicted perforation (HR = 854.88; P < .01).

CONCLUSIONS

Through-the-scope gastroduodenal stenting tended to be ineffective in patients with poor performance status and long stenosis sites. Stent dysfunction occurred more frequently in patients with poorer performance status. Deployment of 2 stents was a risk factor for perforation. Identification of these risk variables may help yield better gastroduodenal stenting outcomes.

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Endo S, Yamada T, Ikenaga M, Konishi K, Ohta K, Matsumoto K, Takayama H, Kobayashi I, Akamatsu H, Sasaki K, Murata J, Nishikawa K, Nishijima J. Prognostic Factors of Oral Intake After Endoscopic Gastroduodenal Stent Placement for Advanced Gastric Cancer. Surg Laparosc Endosc Percutan Tech 2016;26:368-371. [PMID: 27579982 DOI: 10.1097/sle.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Sato T, Hara K, Mizuno N, Hijioka S, Imaoka H, Yogi T, Tsutsumi H, Fujiyoshi T, Niwa Y, Tajika M, Tanaka T, Ishihara M, Kubota K, Nakajima A, Yamao K. Type of Combined Endoscopic Biliary and Gastroduodenal Stenting Is Significant for Biliary Route Maintenance. Intern Med 2016;55:2153-61. [PMID: 27522990 DOI: 10.2169/internalmedicine.55.6410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open

Self-expandable metal stent placement for malignant duodenal obstruction distal to the bulb. Eur J Gastroenterol Hepatol 2015;27:1466-72. [PMID: 26426837 DOI: 10.1097/meg.0000000000000479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]

Chen SY, Shi H, Jiang SJ, Wang YG, Lin K, Xie ZF, Liu XJ. Transgastric endoscopic gastrojejunostomy using holing followed by interrupted suture technique in a porcine model. World J Gastrointest Endosc 2015;7:1186-1190. [PMID: 26504508 PMCID: PMC4613808 DOI: 10.4253/wjge.v7.i15.1186] [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: 06/25/2015] [Revised: 07/26/2015] [Accepted: 09/13/2015] [Indexed: 02/05/2023] Open

Kim SH, Chun HJ, Yoo IK, Lee JM, Nam SJ, Choi HS, Kim ES, Keum B, Seo YS, Jeen YT, Lee HS, Um SH, Kim CD. Predictors of the patency of self-expandable metallic stents in malignant gastroduodenal obstruction. World J Gastroenterol 2015;21:9134-9141. [PMID: 26290640 PMCID: PMC4533045 DOI: 10.3748/wjg.v21.i30.9134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/12/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open

Hori Y, Naitoh I, Ban T, Narita K, Nakazawa T, Hayashi K, Miyabe K, Shimizu S, Kondo H, Nishi Y, Yoshida M, Umemura S, Kato A, Yamada T, Ando T, Joh T. Stent under-expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction. J Gastroenterol Hepatol 2015;30:1246-51. [PMID: 25708096 DOI: 10.1111/jgh.12933] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 12/28/2022]

Affiliation(s)

Yasuki Hori Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Itaru Naitoh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Tesshin Ban Department of Gastroenterology, Nagoya Daini Red cross Hospital, Nagoya, Japan
Kei Narita Department of Gastroenterology, Gamagori City Hospital, Gamagori, Japan
Takahiro Nakazawa Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Kazuki Hayashi Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Katsuyuki Miyabe Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Shuya Shimizu Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Hiromu Kondo Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Yuji Nishi Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Michihiro Yoshida Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Shuichiro Umemura Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Akihisa Kato Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Tomonori Yamada Department of Gastroenterology, Nagoya Daini Red cross Hospital, Nagoya, Japan
Tomoaki Ando Department of Gastroenterology, Gamagori City Hospital, Gamagori, Japan
Takashi Joh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

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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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Poincloux L, Goutorbe F, Rouquette O, Mulliez A, Goutte M, Bommelaer G, Abergel A. Biliary stenting is not a prerequisite to endoscopic placement of duodenal covered self-expandable metal stents. Surg Endosc 2015;30:437-445. [PMID: 25894447 DOI: 10.1007/s00464-015-4216-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/06/2015] [Indexed: 12/20/2022]

Abstract

BACKGROUND

Duodenal covered self-expandable metal stent (cSEMS) can be used in malignant or benign gastroduodenal obstruction. The need for biliary stenting in patients with no concomitant biliary stricture, before duodenal cSEMS placement, remains unknown. The aim of this study was to determine whether cSEMS placement is responsible for biliary obstruction.

METHODS

This is a single-center, retrospective, case-controlled study, including 106 patients with symptomatic gastric outlet obstruction or duodenal fistula who received a covered nitinol duodenal stent by using through-the-scope/over-the-wire placement procedure. The main outcome measurement was the occurrence comparison of jaundice and bilirubin level, between patients with previous or concomitant biliary stenting (cSEMS + BS group), and patients with no biliary stent (cSEMS group) during an observational period of 90 days.

RESULTS

Hundred and six patients underwent cSEMS placement between June 2005 and March 2014: 53 in the cSEMS group (58% male, mean age 66.4 ± 13.3 years) and 53 in cSEMS + BS group (60% male, mean age 70.4 ± 11.6 years). The obstruction was due to cancer in 45% in cSEMS group and 87% in cSEMS + BS group. No case of jaundice was reported in the cSEMS group or in the cSEMS + BS group. In cSEMS group, the mean bilirubin level (μmol/L ± SD) was 8.0 ± 4 at baseline and 8.5 ± 4.6 at day 10, while in the cSEMS + BS group it was 91.4 ± 108 at baseline and 35.3 ± 39 at day 10 (p < 0.01). Patients from the two groups were matched on age, gender and bilirubin level at baseline. Evolution of bilirubinemia was +0.98 ± 2.76 µmol/L in experimental group and +0.39 ± 522 µmol/L in the control group (p = 0.34). No significant difference was observed between the two groups in term of technical success, clinical effectiveness, migration and other complications.

CONCLUSIONS

Previous biliary stenting is not required before endoscopic covered duodenal stent placement in patients with no associated biliary obstruction. Prospective studies are needed.

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Tol J, Busch O, van Gulik T, Gouma D. Pancreatic Cancer: The Role of Bypass Procedures. PANCREATIC CANCER, CYSTIC NEOPLASMS AND ENDOCRINE TUMORS 2015:83-93. [DOI: 10.1002/9781118307816.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]

Trotter JM, Balamurugan R, Dear KL, Naylor GM, Everitt NJ, Ravi K. Non-centralised service for palliative stenting of malignant gastric outlet obstruction. Ann R Coll Surg Engl 2015;97:32-4. [PMID: 25519263 DOI: 10.1308/003588414x14055925058995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open

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]

Sato T, Hara K, Mizuno N, Hijioka S, Imaoka H, Niwa Y, Tajika M, Tanaka T, Ishihara M, Shimizu Y, Bhatia V, Kobayashi N, Endo I, Maeda S, Nakajima A, Kubota K, Yamao K. Gastroduodenal stenting with Niti-S stent: long-term benefits and additional stent intervention. Dig Endosc 2015;27:121-9. [PMID: 24754262 DOI: 10.1111/den.12300] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/07/2014] [Indexed: 12/18/2022]