Enteral stents for malignancy: a report of 46 consecutive cases over 10 years, with critical review of complications.
BACKGROUND
Current management of malignant gastric outlet obstruction (GOO) includes surgical diversion or enteral stent placement for unresectable cancer. We analyzed the long-term results, predictive factors of outcomes, and complications associated with enteral stents with focus on their management.


METHODS
Between 1997 and 2007, 46 patients with malignant GOO underwent placement of self-expandable metal stents (SEMS) for palliation. Patients were captured prospectively after 2001 and followed until complication or death. Patency, management of complications, and long-term survival were analyzed.


RESULTS
Forty-six patients had a mean survival of 152 +/- 235 days and a mean SEMS patency rate of 111 +/- 220 days. SEMS patency rates of 98%, 74%, and 57% at 1, 3, and 6 months were seen. Thirteen patients presented with obstruction and included two SEMS migration, two early occlusion, one fracture, four malignant ingrowth, and four with delayed clinical failure. Interventions included seven endoscopic revisions with three SEMS replacements. Six had percutaneous endoscopic gastrostomy with jejunal arm placed. Two patients eventually underwent surgical bypass. Two patients required surgery for complications including delayed duodenal perforation and aortoenteric fistula.


CONCLUSIONS
SEMS effectively palliate gastric outlet obstructions that result from upper gastrointestinal malignancies. Their benefits offset potential complications or malfunctions, when a pluridisciplinary approach is adopted.
Phillips
Melissa S
MS
Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Gosain
Sonia
S
Bonatti
Hugo
H
Friel
Charles M
CM
Ellen
Kristi
K
Northup
Patrick G
PG
Kahaleh
Michel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015607:Stents; D016019:Survival Analysis