title: Role of intervention for biliary and gastric/intestinal obstruction in gastric cancer with peritoneal metastasis.
abstract: OBJECTIVE
  Gastrointestinal (GI) luminal obstruction or malignant biliary obstruction (MBO) is not a rare condition in gastric cancer patients with peritoneal metastasis. The role of endoscopic or percutaneous interventions is not fully elucidated in this setting.
  
  
  METHODS
  A total of 123 patients with unresectable or recurrent gastric adenocarcinoma with peritoneal metastasis receiving intravenous and intraperitoneal paclitaxel combined with S-1 were retrospectively studied. Safety and efficacy of interventions for GI luminal obstruction and MBO were evaluated.
  
  
  RESULTS
  A total of 27 patients (22%) underwent GI luminal and/or biliary interventions; GI luminal alone in 10, biliary alone in 10 and both in seven, with a technical success rate of 100%. Clinical success rate was 65% in self-expandable metallic stents (SEMS) placement for GI luminal obstruction. Eastern Cooperative Oncology Group (ECOG) performance status (PS) was prognostic of clinical success in GI luminal stenting (100% in PS of 1 vs 14% in PS of 2-3, P < 0.001). Biliary drainage (endoscopic SEMS placement in four and percutaneous transhepatic biliary drainage in 12) relieved obstructive jaundice in 94%. Six complications were observed: four after GI luminal stenting (two occlusion and one aspiration pneumonia) and two after biliary stenting (one cholangitis and one cholecystitis). Median survival after the initial intervention was 5.7 months. PS at interventions was prognostic of survival after interventions (12.3 months in PS of 1 vs 2.2 months in PS of 2 or 3, P < 0.001).
  
  
  CONCLUSIONS
  Endoscopic or percutaneous interventions for GI luminal obstruction or MBO were feasible and effective in gastric cancer patients with peritoneal dissemination receiving combination chemotherapy.
authors: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. ynakai-tky@umin.ac.jp
authors: Yousuke
authors: Y
authors: Nakai
authors: Hironori
authors: H
authors: Ishigami
authors: Hiroyuki
authors: H
authors: Isayama
authors: Takashi
authors: T
authors: Sasaki
authors: Kazumichi
authors: K
authors: Kawakubo
authors: Hirofumi
authors: H
authors: Kogure
authors: Shigenobu
authors: S
authors: Emoto
authors: Hironori
authors: H
authors: Yamaguchi
authors: Joji
authors: J
authors: Kitayama
authors: Natsuyo
authors: N
authors: Yamamoto
authors: Naoki
authors: N
authors: Sasahira
authors: Kenji
authors: K
authors: Hirano
authors: Minoru
authors: M
authors: Tada
authors: Kazuhiko
authors: K
authors: Koike
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000556:secondary* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D004338:Drug Combinations; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010094:Oxonic Acid / Q000008:administration & dosage; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000556:secondary*; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D017239:Paclitaxel