title: Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction.
abstract: BACKGROUND
  Endoscopically inserted self-expandable metal stents (SEMSs) are used to palliate malignant gastric outlet obstruction (GOO). Peritoneal disease is considered a relative contraindication to SEMS placement given the risk of multifocal obstruction.
  
  
  OBJECTIVE
  To evaluate the success of SEMSs placed in patients with GOO with carcinomatosis.
  
  
  METHODS
  Retrospective review of patients who underwent SEMS placement for malignant GOO.
  
  
  METHODS
  Large, urban cancer center.
  
  
  METHODS
  A total of 215 patients who were scheduled for SEMS placement for GOO.
  
  
  METHODS
  SEMS placement.
  
  
  METHODS
  Technical success, clinical success, early and late SEMS failure, and complications.
  
  
  RESULTS
  Technical success was achieved in 192 of 201 patients (95.5%). Of the 9 patients who did not achieve technical success, 6 had carcinomatosis. Among the 116 patients (60%) with carcinomatosis, clinical success was achieved 94 of them (81%). Of these 94 patients, 17 (18%) required reinterventions: 4 for early SEMS failure and 13 for late SEMS failure. Among the 76 patients (40%) without carcinomatosis, clinical success was achieved in 64 of them (84%). Of these 64 patients, 17 (27%) required reinterventions: 4 for early SEMS failure and 13 for late SEMS failure. Complication rates were similar for both groups.
  
  
  CONCLUSIONS
  This was a retrospective review with experienced clinicians selecting patients whom they thought would benefit from SEMS placement.
  
  
  CONCLUSIONS
  This is the first study to evaluate the effect of carcinomatosis on the technical and clinical success of SEMSs in the palliation of malignant GOO. We found clinical outcomes comparable to those without peritoneal disease. Carcinomatosis should not be considered a contraindication to SEMS placement in selected patients with malignant GOO.
authors.affiliation: Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. mendelsr@mskcc.org
authors.forename: Robin B
authors.initials: RB
authors.lastname: Mendelsohn
authors.forename: Hans
authors.initials: H
authors.lastname: Gerdes
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Markowitz
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DiMaio
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schattner
mesh_terms: D000368:Aged; D001201:Ascites / Q000209:etiology; D000075202:Contraindications; D004067:Digestive System Neoplasms / Q000150:complications* / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D004868:Equipment Failure; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome