Open Access
CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1487-E1494
DOI: 10.1055/a-1237-3956
Original article

Palliative treatment for malignant gastrointestinal obstruction with peritoneal carcinomatosis: enteral stenting versus surgery

Veeravich Jaruvongvanich
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
FNU Chesta
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Anushka Baruah
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Meher Oberoi
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Daniel Adamo
2   Division of Radiology, Mayo Clinic, Rochester, Minnesota, United States
,
Prabh G. Singh
3   Government Medical College and Hospital, Chandigarh, India
,
Alyssa Meyer
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Ryan J. Law
4   University of Michigan, Gastroenterology and Hepatology, Ann Arbor, Michigan, United States
,
Navtej Buttar
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
› Institutsangaben
Preview

Abstract

Background and study aims Management of malignant gastrointestinal obstruction (MGIO) is more challenging in the presence of peritoneal carcinomatosis (PC). Outcomes data to guide the management of MGIO with PC are lacking. We aimed to compare the clinical outcomes and adverse events between endoscopic and surgical palliation and identify predictors of stent success in patients with MGIO with PC.

Patients and methods Consecutive inpatients with MGIO with PC between 2000 and 2018 who underwent palliative surgery or enteral stenting were included. Clinical success was defined as relief of obstructive symptoms.

Results Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared. The two groups did not differ in rates of technical success, 30-day mortality, or recurrence. Clinical success from a single intervention (63.2 % versus 95 %), luminal patency duration (27 days vs. 145 days), and survival length (148 days vs. 336 days) favored palliative surgery (all P < 0.05) but the patients in the surgery group had a trend toward better Eastern Cooperative Oncology Group (ECOG) status. The rate of adverse events (AEs) (10.5 % vs. 50 %), the severity of AEs, and length of hospital stay (4.5 days vs. 9 days) favored enteral stenting (P < 0.05). The need for more than one stent was associated with a higher likelihood of stent failure.

Conclusions Our study suggests that enteral stenting is safer and associated with a shorter hospital stay than palliative surgery, although unlike other MGIOs, clinical success is lower in MGIO with PC. Identification of the right candidates and potential predictors of clinical success in ECOG-matched large-scale studies is needed to validate these results.

Supplementary material



Publikationsverlauf

Eingereicht: 17. Februar 2020

Angenommen: 07. Juli 2020

Artikel online veröffentlicht:
07. Oktober 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany