Download PDF
CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2019; 10(01): 021-027
DOI: 10.4103/jde.JDE_64_18
Review Article
Journal of Digestive Endoscopy

Antroduodenal Stenting for Malignant Gastric Outlet Obstruction: Technique and Outcome

Uday C. Ghoshal
Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Vinay Kumar
Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
› Author Affiliations
Further Information

Publication History

Publication Date:
16 September 2019 (online)

   Permissions and Reprints

ABSTRACT

Gastric outlet obstruction (GOO) is usually a late presentation of gastric cancer, pancreaticobiliary malignancy, and extrinsic lymph nodal compression. Presenting symptoms are abdominal pain, postprandial epigastric fullness, and recurrent vomiting, which lead to severe malnutrition and dehydration and poor quality of life (QoL). Endoscopic enteral stent placement has become the acceptable alternative modality for palliation of malignant GOO because it is safe, minimally invasive, and a cost-effective procedure. In addition, endoscopic stent placement leads to shorter time to resume oral diet and shorter hospital stay in comparison to surgical bypass. Endoscopic stent placement is associated with high technical as well as clinical success rates and improvement in QoL, but no survival improvement. Recurrence of symptoms occurs due to stent occlusion, or stent migration, which can be successfully managed with repeat endoscopic stent placement. Perforation and bleeding are serious but rare complications.

KEYWORDS

Enteral nutrition - enteral stent - gallbladder cancer - gastric cancer - gastric outlet obstruction - vomiting
 

  • REFERENCES

  • 1 Didden P, Spaander MC, de Ridder R, Berk L, van Tilburg AJ, Leeuwenburgh I. et al. Efficacy and safety of a partially covered stent in malignant gastric outlet obstruction: A prospective Western series. Gastrointest Endosc 2013; 77: 664-8
    CrossrefPubMedGoogle Scholar
  • 2 Tringali A, Didden P, Repici A, Spaander M, Bourke MJ, Williams SJ. et al. Endoscopic treatment of malignant gastric and duodenal strictures: A prospective, multicenter study. Gastrointest Endosc 2014; 79: 66-75
    CrossrefPubMedGoogle Scholar
  • 3 Kanno Y, Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J. et al. Efficacy and safety of a WallFlex enteral stent for malignant gastric obstruction. Dig Endosc 2013; 25: 386-91
    CrossrefPubMedGoogle Scholar
  • 4 van Hooft JE, Dijkgraaf MG, Timmer R, Siersema PD, Fockens P. Independent predictors of survival in patients with incurable malignant gastric outlet obstruction: A multicenter prospective observational study. Scand J Gastroenterol 2010; 45: 1217-22
    CrossrefPubMedGoogle Scholar
  • 5 Cho YK, Kim SW, Hur WH, Nam KW, Chang JH, Park JM. et al. Clinical outcomes of self-expandable metal stent and prognostic factors for stent patency in gastric outlet obstruction caused by gastric cancer. Dig Dis Sci 2010; 55: 668-74
    CrossrefPubMedGoogle Scholar
  • 6 Mehta S, Hindmarsh A, Cheong E, Cockburn J, Saada J, Tighe R. et al. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc 2006; 20: 239-42
    CrossrefPubMedGoogle Scholar
  • 7 Weaver DW, Wiencek RG, Bouwman DL, Walt AJ. Gastrojejunostomy: Is it helpful for patients with pancreatic cancer?. Surgery 1987; 102: 608-13
    PubMedGoogle Scholar
  • 8 van Wagensveld BA, Coene PP, van Gulik TM, Rauws EA, Obertop H, Gouma DJ. et al. Outcome of palliative biliary and gastric bypass surgery for pancreatic head carcinoma in 126 patients. Br J Surg 1997; 84: 1402-6
    CrossrefPubMedGoogle Scholar
  • 9 Nagaraja V, Eslick GD, Cox MR. Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction-a systematic review and meta-analysis of randomized and non-randomized trials. J Gastrointest Oncol 2014; 5: 92-8
    CrossrefPubMedGoogle Scholar
  • 10 Telford JJ, Carr-Locke DL, Baron TH, Tringali A, Parsons WG, Gabbrielli A. et al. Palliation of patients with malignant gastric outlet obstruction with the enteral wallstent: Outcomes from a multicenter study. Gastrointest Endosc 2004; 60: 916-20
    CrossrefPubMedGoogle Scholar
  • 11 Park JM, Min BH, Lee SH, Chung KH, Lee JM, Song BJ. et al. Feasibility of self-expandable metal stent placement with side-viewing endoscope for malignant distal duodenal obstruction. Dig Dis Sci 2015; 60: 524-30
    CrossrefPubMedGoogle Scholar
  • 12 Sasaki R, Sakai Y, Tsuyuguchi T, Nishikawa T, Fujimoto T, Mikami S. et al. Endoscopic management of unresectable malignant gastroduodenal obstruction with a nitinol uncovered metal stent: A prospective Japanese multicenter study. World J Gastroenterol 2016; 22: 3837-44
    CrossrefPubMedGoogle Scholar
  • 13 Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using Self-expanding metal stents: Experience in 36 patients. Am J Gastroenterol 2002; 97: 72-8
    CrossrefPubMedGoogle Scholar
  • 14 Song HY, Shin JH, Yoon CJ, Lee GH, Kim TW, Lee SK. et al. A dual expandable nitinol stent: Experience in 102 patients with malignant gastroduodenal strictures. J Vasc Interv Radiol 2004; 15: 1443-9
    CrossrefPubMedGoogle Scholar
  • 15 Lye TJ, Goh YC, Eng AK, Ong HS, Wong WK, Chan WH. et al. Endoscopic self-expandable metallic stenting for palliation of malignant gastric outlet obstruction in Southeast Asia. ANZ J Surg 2016; 86: 464-468
    CrossrefPubMedGoogle Scholar
  • 16 Misra SP, Dwivedi M, Misra V. Malignancy is the most common cause of gastric outlet obstruction even in a developing country. Endoscopy 1998; 30: 484-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Sukumar V, Ravindran C, Prasad RV. Demographic and etiological patterns of gastric outlet obstruction in Kerala, South India. N Am J Med Sci 2015; 7: 403-6
    CrossrefPubMedGoogle Scholar
  • 18 Sikora SS, Kapoor R, Pradeep R, Kapoor VK, Saxena R, Kaushik SP. et al. Palliative surgical treatment of malignant obstructive jaundice. Eur J Surg Oncol 1994; 20: 580-4
    PubMedGoogle Scholar
  • 19 Gaidos JK, Draganov PV. Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents. World J Gastroenterol 2009; 15: 4365-71
    CrossrefPubMedGoogle Scholar
  • 20 Lau JY, Chung SC, Sung JJ, Chan AC, Ng EK, Suen RC. et al. Through-the-scope balloon dilation for pyloric stenosis: Long-term results. Gastrointest Endosc 1996; 43: 98-101
    CrossrefPubMedGoogle Scholar
  • 21 Del Piano M, Ballarè M, Montino F, Todesco A, Orsello M, Magnani C. et al. Endoscopy or surgery for malignant GI outlet obstruction?. Gastrointest Endosc 2005; 61: 421-6
    CrossrefPubMedGoogle Scholar
  • 22 Bozzetti F, Bonfanti G, Audisio RA, Doci R, Dossena G, Gennari L. et al. Prognosis of patients after palliative surgical procedures for carcinoma of the stomach. Surg Gynecol Obstet 1987; 164: 151-4
    PubMedGoogle Scholar
  • 23 Ly J, O’Grady G, Mittal A, Plank L, Windsor JA. A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc 2010; 24: 290-7
    CrossrefPubMedGoogle Scholar
  • 24 Mittal A, Windsor J, Woodfield J, Casey P, Lane M. Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 2004; 91: 205-9
    CrossrefPubMedGoogle Scholar
  • 25 Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: A systematic review. BMC Gastroenterol 2007; 7: 18
    CrossrefPubMedGoogle Scholar
  • 26 Khashab MA, Kumbhari V, Grimm IS, Ngamruengphong S, Aguila G, El Zein M. et al. EUS-guided gastroenterostomy: The first US. Clinical experience (with video). Gastrointest Endosc 2015; 82: 932-8
    CrossrefPubMedGoogle Scholar
  • 27 Chen YI, Itoi T, Baron TH, Nieto J, Haito-Chavez Y, Grimm IS. et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 2017; 31: 2946-52
    CrossrefPubMedGoogle Scholar
  • 28 Song HY, Yang DH, Kuh JH, Choi KC. Obstructing cancer of the gastric antrum: Palliative treatment with covered metallic stents. Radiology 1993; 187: 357-8
    CrossrefPubMedGoogle Scholar
  • 29 Strecker EP, Boos I, Husfeldt KJ. Malignant duodenal stenosis: Palliation with peroral implantation of a Self-expanding nitinol stent. Radiology 1995; 196: 349-51
    CrossrefPubMedGoogle Scholar
  • 30 Wai CT, Ho KY, Yeoh KG, Lim SG. Palliation of malignant gastric outlet obstruction caused by gastric cancer with self-expandable metal stents. Surg Laparosc Endosc Percutan Tech 2001; 11: 161-4
    CrossrefPubMedGoogle Scholar
  • 31 Kim GH, Kang DH, Lee DH, Heo J, Song GA, Cho M. et al. Which types of stent, uncovered or covered, should be used in gastric outlet obstructions?. Scand J Gastroenterol 2004; 39: 1010-4
    CrossrefPubMedGoogle Scholar
  • 32 van Hooft JE, Uitdehaag MJ, Bruno MJ, Timmer R, Siersema PD, Dijkgraaf MG. et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): A prospective multicenter study. Gastrointest Endosc 2009; 69: 1059-66
    CrossrefPubMedGoogle Scholar
  • 33 Kim CG, Choi IJ, Lee JY, Cho SJ, Park SR, Lee JH. et al. Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: A randomized, prospective study. Gastrointest Endosc 2010; 72: 25-32
    CrossrefPubMedGoogle Scholar
  • 34 Pan YM, Pan J, Guo LK, Qiu M, Zhang JJ. 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
    CrossrefPubMedGoogle Scholar
  • 35 Maetani I, Mizumoto Y, Shigoka H, Omuta S, Saito M, Tokuhisa J. et al. Placement of a triple-layered covered versus uncovered metallic stent for palliation of malignant gastric outlet obstruction: A multicenter randomized trial. Dig Endosc 2014; 26: 192-9
    CrossrefPubMedGoogle Scholar
  • 36 Lim SG, Kim JH, Lee KM, Shin SJ, Kim CG, Kim KH. et al. Conformable covered versus uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction: A randomized prospective study. Dig Liver Dis 2014; 46: 603-8
    CrossrefPubMedGoogle Scholar
  • 37 Lee H, Min BH, Lee JH, Shin CM, Kim Y, Chung H. et al. Covered metallic stents with an anti-migration design vs. Uncovered stents for the palliation of malignant gastric outlet obstruction: A multicenter, randomized trial. Am J Gastroenterol 2015; 110: 1440-9
    CrossrefPubMedGoogle Scholar
  • 38 Jung K, Ahn JY, Jung HY, Cho CJ, Na HK, Jung KW. et al. Outcomes of endoscopically inserted self-expandable metal stents in malignancy according to the type of stent and the site of obstruction. Surg Endosc 2016; 30: 4001-10
    CrossrefPubMedGoogle Scholar
  • 39 Oh D, Lee SS, Song TJ, Choi JH, Park DH, Seo DW. et al. Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction: A pilot study. Gastrointest Endosc 2015; 82: 32-60
    CrossrefPubMedGoogle Scholar
  • 40 Nassif T, Prat F, Meduri B, Fritsch J, Choury AD, Dumont JL. et al. Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: Results of a multicenter study. Endoscopy 2003; 35: 483-9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Maetani I, Ukita T, Tada T, Shigoka H, Omuta S, Endo T. Metallic stents for gastric outlet obstruction: Reintervention rate is lower with uncovered versus covered stents, despite similar outcomes. Gastrointest Endosc 2009; 69: 806-12
    CrossrefPubMedGoogle Scholar
  • 42 Phillips MS, Gosain S, Bonatti H, Friel CM, Ellen K, Northup PG. et al. Enteral stents for malignancy: A report of 46 consecutive cases over 10 years, with critical review of complications. J Gastrointest Surg 2008; 12: 2045-50
    CrossrefPubMedGoogle Scholar
  • 43 Mosler P, Mergener KD, Brandabur JJ, Schembre DB, Kozarek RA. Palliation of gastric outlet obstruction and proximal small bowel obstruction with self-expandable metal stents: A single center series. J Clin Gastroenterol 2005; 39: 124-8
    PubMedGoogle Scholar
  • 44 Shin YS, Choi CW, Kang DH, Kim HW, Kim SJ, Cho M. et al. Factors associated with clinical failure of self-expandable metal stent for malignant gastroduodenal obstruction. Scand J Gastroenterol 2016; 51: 103-10
    CrossrefPubMedGoogle Scholar
  • 45 Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: Systematic review of their clinical effectiveness. Endoscopy 2004; 36: 543-50
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Rademacher C, Bechtler M, Schneider S, Hartmann B, Striegel J, Jakobs R. Self-expanding metal stents for the palliation of malignant gastric outlet obstruction in patients with peritoneal carcinomatosis. World J Gastroenterol 2016; 22: 9554-61
    CrossrefPubMedGoogle Scholar
  • 47 Yamao K, Kitano M, Kayahara T, Ishida E, Yamamoto H, Minaga K. et al. 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
    CrossrefPubMedGoogle Scholar
  • 48 Oh SY, Edwards A, Mandelson M, Ross A, Irani S, Larsen M. et al. Survival and clinical outcome after endoscopic duodenal stent placement for malignant gastric outlet obstruction: Comparison of pancreatic cancer and nonpancreatic cancer. Gastrointest Endosc 2015; 82: 460-800
    CrossrefPubMedGoogle Scholar
  • 49 Larssen L, Medhus AW, Hauge T. Treatment of malignant gastric outlet obstruction with stents: An evaluation of the reported variables for clinical outcome. BMC Gastroenterol 2009; 9: 45
    CrossrefPubMedGoogle Scholar
  • 50 Schmidt C, Gerdes H, Hawkins W, Zucker E, Zhou Q, Riedel E. et al. A prospective observational study examining quality of life in patients with malignant gastric outlet obstruction. Am J Surg 2009; 198: 92-9
    CrossrefPubMedGoogle Scholar
  • 51 Masci E, Viale E, Mangiavillano B, Contin G, Lomazzi A, Buffoli F. et al. Enteral self-expandable metal stent for malignant luminal obstruction of the upper and lower gastrointestinal tract: A prospective multicentric study. J Clin Gastroenterol 2008; 42: 389-94
    CrossrefPubMedGoogle Scholar
  • 52 Lopes CV, Pesenti C, Bories E, Caillol F, Giovannini M. self-expandable metallic stents for palliative treatment of digestive cancer. J Clin Gastroenterol 2008; 42: 991-6
    CrossrefPubMedGoogle Scholar
  • 53 Espinel J, Vivas S, Muñoz F, Jorquera F, Olcoz JL. Palliative treatment of malignant obstruction of gastric outlet using an endoscopically placed enteral wallstent. Dig Dis Sci 2001; 46: 2322-4
    CrossrefPubMedGoogle Scholar
  • 54 Kim TO, Kang DH, Kim GH, Heo J, Song GA, Cho M. et al. self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction caused by stomach cancer. World J Gastroenterol 2007; 13: 916-20
    CrossrefPubMedGoogle Scholar
  • 55 Havemann MC, Adamsen S, Wøjdemann M. Malignant gastric outlet obstruction managed by endoscopic stenting: A prospective single-centre study. Scand J Gastroenterol 2009; 44: 248-51
    CrossrefPubMedGoogle Scholar
  • 56 Kumar V, Ghoshal UC, Mohindra S, Saraswat VA. Palliation of malignant gastroduodenal obstruction with self-expandable metal stent using side- and foward-viewing endoscope: Feasibility and outcome. JGH Open 2018; 3: 65-70
    PubMedGoogle Scholar
  • 57 Sachdeva S, Ghoshal UC, Saraswat VA, Das K, Misra A. Gastroduodenal dysmotility in patients with gallbladder carcinoma: Frequency of occurrence and clinical importance. Natl Med J India 2006; 19: 4-9
    PubMedGoogle Scholar