First data on the palliative treatment of patients with malignant gastric outlet obstruction using the WallFlex enteral stent: a retrospective multicenter study.
OBJECTIVE
Gastric outlet obstruction can occur as a late complication of a variety of cancers. Palliation of the obstructive symptoms is the primary aim of treatment in these patients. Self-expandable metal stents have emerged as a promising treatment option. The purpose of this study was to investigate the short-term (30-day) clinical success and complication rates of a new enteral stent made of nitinol (Boston Scientific WallFlex stent).


METHODS
Between December 2004 and 1 May 2005, 62 patients (35 men, 27 women; mean age 69.9 years) presenting with documented malignancy and symptoms of gastric outlet obstruction underwent endoscopic stenting with the new WallFlex enteral stent at one of the 15 European centers who were the first to have access to this new stent. Data were collected from charts, endoscopy procedure reports, and follow-up clinical visits. The gastric outlet obstruction scoring system (GOOSS) was used to grade the patients' ability to eat.


RESULTS
All 62 patients suffered from nausea, vomiting, or inability to eat. A total of 66 enteral stents were placed. The median length of the stenosis was 4 cm. The clinical success rate was 85% on an intention-to-treat basis. An improvement in the GOOSS score of 1 point was considered to be significant (P < 0.001). Oral intake was possible, on average, 1 day after stent placement. The median hospital stay was 6 days. Thirty days' follow-up data were available for 60 patients, 10 of whom developed complications during this period (17%).


CONCLUSIONS
In this first European series in which duodenal stenting was performed with the WallFlex enteral stent, the new stent appears to be effective and relatively safe for the palliative treatment of patients with malignant gastric outlet obstruction.
van Hooft
J
J
Academic Medical Center, Amsterdam, The Netherlands.
Mutignani
M
M
Repici
A
A
Messmann
H
H
Neuhaus
H
H
Fockens
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004386:Duodenum; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010166:Palliative Care / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome