Background and Study Aims: Gastric outlet obstruction is a late event in the natural history of biliopancreatic
tumours. Metallic self-expanding stents inserted under endoscopic and fluoroscopic
guidance can be used for palliation. The aim of this study was to evaluate the feasibility,
efficacy, and complications of endoscopic duodenal stenting in patients with malignant
gastric outlet obstruction.Patients and Methods: Between August 1998 and November 2001, 63 patients (31 women, 32 men; mean age 73
± 12) presenting with clinical symptoms of duodenal obstruction underwent endoscopic
stenting with large metallic prostheses. Complications and clinical outcome were assessed
both retrospectively and prospectively.Results: Of the patients, 58 needed one duodenal stent and two overlapping stents were required
in five patients. Stenting was immediately successful in 60/63 patients (95 %). At
the time of the duodenal procedure, 25 previously inserted biliary stents were still
patent; biliary stenting was attempted during the same procedure in 18 patients; and
20 patients had no biliary stricture. There was no procedure-related mortality. There
were complications in 30 % of patients: 13 stent obstructions, 4 stent migrations
and 2 duodenal perforations (treated surgically). For 44 patients (70 %) there were
no minor or major digestive problem during their remaining lifetime. An exclusively
peroral diet was possible in 58 patients (92 %), but was considered satisfactory (solid
or soft) in 46/63 patients (73 %). Of the patients, 53 (84 %) died between 1 and 64
weeks after the duodenal stenting (median survival 7 weeks).Conclusions: Endoscopic stenting for the palliation of malignant gastric outlet obstruction is
feasible and well-tolerated in most patients. Most dysfunctions can be managed endoscopically.
References
prat@cochin.inserm.fr
