title: Oral intake throughout the patients' lives after palliative metallic stent placement for malignant gastroduodenal obstruction:  a retrospective multicentre study.
abstract: OBJECTIVE
  Patients with inoperable malignant gastric outlet obstruction (GOO) have been managed with self-expandable metal stents to improve oral intake. Recent studies have shown conflicting results on the capacity of self-expandable metal stents to restore food intake in the long term. This study evaluated the clinical effectiveness of enteral stent placement for GOO throughout the patients' lives.
  
  
  METHODS
  This was a multicentre, retrospective study with a long-term follow-up of 74 patients who underwent enteral stenting for symptomatic GOO. Data were collected to analyse improvements in oral intake for the patients' entire lives as assessed by the GOO scoring system (GOOSS), technical success, stent patency, complications, the need for reintervention, survival and the prognostic factors associated with stent patency.
  
  
  RESULTS
  Technical and clinical success was achieved in 100 and 97.2% of the patients, respectively. A total of 71/74 patients (95.9%) continued oral intake for the rest of their lives and 58/74 patients (78.4%) needed no further intervention until death. Solid food intake (GOOSS 2-3) continued until death in 47/74 patients (63.5%). The GOOSS score improved (P<0.001) during the follow-up compared with the baseline. The median survival and the mean stent patency were 8 and 76.6 weeks, respectively. The complication rate was 18.9%. Malignant stent reobstruction was observed in 7/74 patients (9.5%). A Cox multivariate analysis showed that duodenal location of the obstruction was the only independent factor associated with stent patency (hazard ratio=5.28; 95% confidence interval=1.14-24.45; P=0.033).
  
  
  CONCLUSIONS
  Enteral stenting in patients with unresectable GOO is safe and clinically effective. Ninety-five per cent of patients are able to resume oral intake for the rest of their lives, and the great majority remain free from further intervention. In approximately two-thirds of patients, solid food intake continues until death.
authors.affiliation: Department of Gastroenterology, Pulido Valente Hospital, Faculty of Medical Sciences, Lisbon, Portugal. jmtcanena@live.com.pt
authors.forename: Jorge M
authors.initials: JM
authors.lastname: Canena
authors.forename: Ana C
authors.initials: AC
authors.lastname: Lagos
authors.forename: Inês N
authors.initials: IN
authors.lastname: Marques
authors.forename: Sara D
authors.initials: SD
authors.lastname: Patrocínio
authors.forename: Miguel G
authors.initials: MG
authors.lastname: Tomé
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Liberato
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Romão
authors.forename: António P
authors.initials: AP
authors.lastname: Coutinho
authors.forename: Pedro M
authors.initials: PM
authors.lastname: Veiga
authors.forename: Beatriz C
authors.initials: BC
authors.lastname: Neves
authors.forename: Hélder D
authors.initials: HD
authors.lastname: Além
authors.forename: José A
authors.initials: JA
authors.lastname: Gonçalves
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004067:Digestive System Neoplasms / Q000150:complications*; D004435:Eating; D004750:Enteral Nutrition; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome