title: Outcome for self-expandable metal stents in malignant gastroduodenal obstruction: single-center experience with 104 patients.
abstract: BACKGROUND
  Malignant gastric outlet obstruction (GOO) leads to malnutrition and limits quality of life. Gastrojejunostomy has been the traditional treatment for GOO. Recently, the results of releasing duodenal obstruction with self-expandable metal stents (SEMS) have been encouraging.
  
  
  METHODS
  After the exclusion of 13 patients with gastrojejunal or jejunal strictures and 1 patient with intraabdominal lymphoma, the authors palliated the malignant GOO in 104 patients with 130 SEMS at a single center during the years 1999-2007.
  
  
  RESULTS
  The GOO was caused by pancreatic (n = 51), gastric (n = 24), duodenal (n = 7), biliary (n = 5), and other (n = 17) malignancies. Of the 104 patients, 76 (73%) did well with only one enteral stent placement, 21 (20.2%) required two stent placements, 4 (3.8%) required three stent placements, and 1 required four stent placements. The median dysphagia score was 0 before stenting and 2 after treatment (p < 0.001). Immediate failure occurred after 10 procedures (7.7%). Among the 104 patients, 6 (5.8%) died of stent placement-related reasons. Complications occurred for 13 patients (12.5%). The median hospital stay was 3 days, and the overall survival time was 62 days (range, 1-933 days). Of 11 patients with concomitant biliary obstruction and GOO, 10 (91%) underwent successful enteral and biliary stent placement within the same session. Of 15 patients experiencing jaundice after enteral stent placement, 6 (40%) underwent endoscopic biliary drainage successfully.
  
  
  CONCLUSIONS
  Enteral stenting is a safe and effective way to treat GOO. Gastrojejunostomy should be preserved for cases in which endoscopic stenting is not successful or possible.
authors.affiliation: Department of Gastrointestinal and General Surgery, Meilahti Hospital, University of Helsinki, PO Box 340, 00029, Helsinki, Finland.
authors.forename: Ilona
authors.initials: I
authors.lastname: Keränen
authors.forename: Marianne
authors.initials: M
authors.lastname: Udd
authors.forename: Anna
authors.initials: A
authors.lastname: Lepistö
authors.forename: Jorma
authors.initials: J
authors.lastname: Halttunen
authors.forename: Leena
authors.initials: L
authors.lastname: Kylänpää
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004067:Digestive System Neoplasms / Q000150:complications* / Q000401:mortality; D004380:Duodenal Obstruction / Q000209:etiology / Q000601:surgery*; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents