title: Treatment of malignant gastric outlet obstruction with metallic stents:  assessment of whether gastrointestinal position alters efficacy.
abstract: OBJECTIVE
  Gastric outlet obstruction (GOO) is a late complication of advanced gastric, pancreatic, and duodenal cancer. Palliative treatment of the obstruction is the main aim of therapy for these patients. Self-expandable metal stents are used for treating GOO. From our experience, the placement of the stent across the pylorus is easier and makes the curve of stent better than when the stent is placed within the duodenal area. The purposes of this study were to assess the efficacy of stents placed in either the duodenal area or across the pyloric valve in relieving GOO symptoms and to evaluate whether the location of the stent affects treatment outcomes.
  
  
  METHODS
  This was a retrospective single-site study of 44 patients with malignant GOO. Expanding metal stents were placed either across the pyloric valve (n = 22; group A) or in the duodenum area (n = 22; group B). Improvement in oral intake was monitored using the Gastric Outlet Obstruction Scoring System (GOOSS). The end of the study was death of the last enrolled patient or 6 months after enrollment of the last patient, or whatever came first.
  
  
  RESULTS
  Stent implantation similarly improved the patients' tolerance for food intake from baseline for both groups A and B (median [interquartile range]; 2 [2-3] and 2 [2-3], respectively). Patients in group B who received adjunctive chemotherapy had greater improvement in GOOSS and survival than patients in group B who did not have chemotherapy or any group A patients (P < 0.05). Stent patency was not affected by stent position or chemotherapy.
  
  
  CONCLUSIONS
  Palliative treatment of GOO with placement of an expandable metal stent improved the tolerability of food intake. The location of stent across the pyloric valve or within the duodenum did not affect the efficacy of the procedure or stent patency.
authors: Division of Digestive Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors: Hao-Tsai
authors: HT
authors: Cheng
authors: Ching-Song
authors: CS
authors: Lee
authors: Cheng-Hui
authors: CH
authors: Lin
authors: Chi-Liang
authors: CL
authors: Cheng
authors: Jui-Hsiang
authors: JH
authors: Tang
authors: Yung-Kuan
authors: YK
authors: Tsou
authors: Jui-Min
authors: JM
authors: Chang
authors: Mu-Hsien
authors: MH
authors: Lee
authors: Kai-Feng
authors: KF
authors: Sung
authors: Nai-Jen
authors: NJ
authors: Liu
mesh_terms: D000368:Aged; D005260:Female; D017219:Gastric Outlet Obstruction / Q000473:pathology* / Q000628:therapy*; D041981:Gastrointestinal Tract / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals