title: Self-expanding metal stents for duodenal obstruction in advanced pancreatic adenocarcinoma.
abstract: BACKGROUND
  Gastric outlet obstruction (GOO) is a frequent feature of advanced pancreatic carcinoma. Self-expandable metal stents (SEMS) allow the condition to be managed outside by endoscopy rather than surgical bypass. The aim of this study is to report our experience in a district general hospital with SEMS for palliation of pancreatic carcinoma-related GOO.
  
  
  METHODS
  All patients admitted with or developing GOO secondary to pancreatic adenocarcinoma between January 2004 and December 2005 were identified. Notes were retrieved to determine the efficacy of stenting including: complications of the procedure, length of stay, readmissions and long-term patency.
  
  
  RESULTS
  Of 39 new cases of pancreatic cancer, 9 patients presented with (n=6) or developed (n=3) duodenal obstruction. In one patient, previous gastric surgery restricted access. Stenting was attempted in 8 patients (4 M and 4 F) with a mean age of 63 years (range 42-76 years). In one case, the duodenal invasion was too extensive to allow passage of the guide-wire and open bypass was performed. Stenting was successful in the remaining seven patients with no early complications. The median hospital stay post-procedure was 7 days (range 5-11 days). One patient was re-admitted after 11 weeks with recurrent duodenal obstruction and a second stent was placed. The median survival post-stenting was 10 weeks (range 3-28 weeks).
  
  
  CONCLUSIONS
  SEMS allows patients to leave hospital quickly and return to daily activities, albeit for the short term. The procedure requires an experienced interventional endoscopist but can be accomplished safely in the DGH setting.
authors.affiliation: Department of Surgery, Princess of Wales Hospital, Coity Road, Bridgend, Wales, UK. garethmorrisstiff@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: Morris-Stiff
authors.forename: A
authors.initials: A
authors.lastname: Hassn
authors.forename: W T
authors.initials: WT
authors.lastname: Young
references.citation: Gut. 2004 May;53(5):729-34
references.pmid: 15082593
references.citation: Gastrointest Endosc. 2003 Sep;58(3):421-33
references.pmid: 14528223
references.citation: Lancet. 1994 Dec 17;344(8938):1655-60
references.pmid: 7996958
references.citation: Gastrointest Endosc. 1992 Jan-Feb;38(1):58-60
references.pmid: 1377147
references.citation: Endoscopy. 2003 Jun;35(6):483-9
references.pmid: 12783345
references.citation: Endoscopy. 2004 Jan;36(1):73-8
references.pmid: 14722859
references.citation: Am J Gastroenterol. 2006 Apr;101(4):735-42
references.pmid: 16635221
references.citation: CA Cancer J Clin. 2005 Jan-Feb;55(1):10-30
references.pmid: 15661684
references.citation: Gastrointest Endosc. 2004 Dec;60(6):916-20
references.pmid: 15605006
references.citation: J Clin Oncol. 2005 May 20;23(15):3509-16
references.pmid: 15908661
references.citation: J Am Coll Surg. 1998 Oct;187(4):429-42
references.pmid: 9783792
references.citation: J Gastroenterol. 2007 Apr;42(4):283-90
references.pmid: 17464457
references.citation: J Vasc Interv Radiol. 2005 Feb;16(2 Pt 1):247-53
references.pmid: 15713926
references.citation: Dig Dis Sci. 2007 Jan;52(1):276-81
references.pmid: 17160470
references.citation: Curr Treat Options Oncol. 2002 Dec;3(6):449-57
references.pmid: 12392635
references.citation: Eur J Surg Oncol. 2003 May;29(4):368-73
references.pmid: 12711291
references.citation: N Engl J Med. 2002 Apr 11;346(15):1128-37
references.pmid: 11948273
references.citation: Br J Surg. 1988 Dec;75(12):1166-8
references.pmid: 2466520
references.citation: Anticancer Res. 2004 Jan-Feb;24(1):269-71
references.pmid: 15015607
references.citation: Ann Surg. 2005 Oct;242(4):540-4; discussion 544-7
references.pmid: 16192814
references.citation: Clin Gastroenterol Hepatol. 2004 Apr;2(4):273-85
references.pmid: 15067620